Publications by authors named "Anoopindar Bhalla"
Objectives: Pediatric acute respiratory distress syndrome (PARDS) guidelines recommend limiting airway plateau pressure (Pplat) to 28 cm H2O, allowing for higher limits when chest wall compliance (CCW) is poor since less of the pressure is transmitted to lung (transpulmonary pressure). Transpulmonary pressure depends on Pplat and the ratio of lung elastance to respiratory system elastance (EL/ERS). EL/ERS measurement requires esophageal manometry, although it is not routinely available.
View Article and Find Full Text PDFObjective: To evaluate age-related differences in respiratory outcomes among critically ill children with Guillain-Barré syndrome (GBS), focusing on mechanical ventilation (MV) requirements and tracheostomy placement.
Study Design: This retrospective cohort study analyzed data collected prospectively within the Virtual Pediatric Systems registry (2009-2020) for US children <21 years diagnosed with GBS and admitted to an intensive care unit (ICU). The primary outcome evaluated was use of invasive mechanical ventilation (IMV).
Background: Mechanical ventilation strategies that balance lung and diaphragm protection have not been extensively tested in clinical trials.
Methods: We conducted a single-center, phase II randomized controlled trial in children with acute respiratory distress syndrome with two time points of random assignment: the acute and weaning phases of ventilation. Patients in the intervention group were managed with a computerized decision support (CDS) tool, named REDvent, and esophageal manometry to deliver lung and diaphragm protective ventilation.
National Institutes of Health COVID-19 Treatment Guidelines Panel: Perspectives and Lessons Learned.
Ann Intern Med
November 2024
Article Synopsis
- In March 2020, the White House Coronavirus Task Force identified the need for expert treatment guidelines for managing COVID-19 due to its life-threatening nature and lack of known effective treatments.
- The NIH was tasked with quickly assembling a panel of experts to create "living" guidelines, which would be regularly updated as new information about the virus emerged.
- The article reflects on the Panel's experiences over four years, summarizes its final recommendations, discusses ongoing challenges, and notes that the responsibility for COVID-19 guidelines will now shift to professional organizations following the end of the public health emergency.
Article Synopsis
- The study investigates the difference in mechanical power during ventilation in children with acute respiratory distress syndrome (ARDS) when using square flow versus decelerating flow modes.
- It involves a secondary analysis of data from 185 pediatric patients, revealing that mechanical power is statistically lower in square flow (0.46 J · min-1 · kg-1) compared to decelerating flow (0.49 J · min-1 · kg-1).
- The findings suggest that while mechanical power is slightly lower in square flow, the clinical significance remains uncertain, with a notable portion (30%) attributed to overcoming resistance in both modes.
Objective: Our aim was to confirm whether extreme hyperoxemic events had been associated with excess mortality in our diverse critical care population.
Methods: Retrospective analysis of 9 years of data collected in the pediatric and cardiothoracic ICUs in Children's Hospital Los Angeles was performed. The analysis was limited to those mechanically ventilated for at least 24 h, with at least 1 arterial blood gas measurement.
Objectives: We sought to evaluate the association between the carbon dioxide ( co2 ) ventilatory equivalent (VEq co2 = minute ventilation/volume of co2 produced per min), a marker of dead space that does not require a blood gas measurement, and mortality risk. We compared the strength of this association to that of physiologic dead space fraction (V D /V t = [Pa co2 -mixed-expired P co2 ]/Pa co2 ) as well as to other commonly used markers of dead space (i.e.
View Article and Find Full Text PDFAssociation between Age and Mortality in Pediatric and Adult Acute Respiratory Distress Syndrome.
Am J Respir Crit Care Med
April 2024
Article Synopsis
- The study investigates the differences in mortality rates between children and adults with acute respiratory distress syndrome (ARDS), revealing lower mortality in children despite similar severity of illness.
- Using data from various cohorts, researchers found a nonlinear relationship between age and 90-day mortality, with risk increasing more rapidly for individuals aged 11 to 65 years.
- The study concluded that while pediatric ARDS has a lower mortality rate (19%) compared to adults (33% and 67% in different cohorts), age plays a significant role in mortality risk for both children and adults.
Article Synopsis
- This study aims to define immunocompromised-associated pediatric acute respiratory distress syndrome (I-PARDS) and contrast it with regular pediatric acute respiratory distress syndrome (PARDS).
- Data were analyzed from the PARDIE study, which included a wide dataset of children with PARDS across 145 PICUs in 27 countries.
- Findings indicate that children with I-PARDS have a higher severity of illness, increased PICU mortality, and are less likely to be extubated successfully within 28 days compared to those with regular PARDS.
Estimation of inspiratory effort using airway occlusion maneuvers in ventilated children: a secondary analysis of an ongoing randomized trial testing a lung and diaphragm protective ventilation strategy.
Crit Care
November 2023
Article Synopsis
- Monitoring respiratory effort in ventilated pediatric patients is crucial for protecting lung function and diaphragm effectiveness, but current methods like esophageal manometry are invasive and require special training.
- This study analyzed data from children with acute respiratory distress syndrome to correlate changes in esophageal pressure during breathing with airway pressures from three specific occlusion maneuvers.
- Results indicated that expiratory occlusion pressure has the strongest correlation with esophageal pressure changes, suggesting its potential as a reliable, less invasive method to assess respiratory effort in children.
Association Between COVID-19 and Severity of Illness for Children With Hyperglycemic Crisis.
Hosp Pediatr
September 2023
Objectives: Admissions to the ICU for children with hyperglycemic crisis (HGC, defined as diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome, or hyperosmolar ketoacidosis) increased during the COVID-19 pandemic. We sought to identify if severity of illness for HGC also increased from prepandemic to pandemic years 1 and 2.
Methods: Retrospective study of children aged ≤18 years hospitalized in the Pediatric Health Information System for HGC.
Objectives: The worldwide practice and impact of noninvasive ventilation (NIV) in pediatric acute respiratory distress syndrome (PARDS) is unknown. We sought to describe NIV use and associated clinical outcomes in PARDS.
Design: Planned ancillary study to the 2016/2017 prospective Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study.
Mechanical Power Is Associated With Mortality in Pediatric Acute Respiratory Distress Syndrome.
Pediatr Crit Care Med
July 2023
Objectives: Mechanical power (MP) transferred from the ventilator to the lungs has been proposed as a summary variable that may impact mortality in children with acute respiratory distress syndrome (ARDS). To date, no study has shown an association between higher MP and mortality in children with ARDS.
Design: Secondary analysis of a prospective observational study.
Background: The end-tidal alveolar dead space fraction (AVDSf = [PaCO-PCO]/PaCO) is a metric used to estimate alveolar dead space. Higher AVDSf on the first day of mechanical ventilation is associated with mortality and fewer ventilator-free days. It is not clear if AVDSf is associated with length of ventilation in survivors, how AVDSf performs for risk stratification beyond the first day of ventilation, or whether AVDSf adds predictive value to oxygenation (oxygenation index [OI]) or severity of illness (Pediatric Risk of Mortality [PRISM III]) markers.
View Article and Find Full Text PDFMonitoring in Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference.
Pediatr Crit Care Med
February 2023
Objectives: Monitoring is essential to assess changes in the lung condition, to identify heart-lung interactions, and to personalize and improve respiratory support and adjuvant therapies in pediatric acute respiratory distress syndrome (PARDS). The objective of this article is to report the rationale of the revised recommendations/statements on monitoring from the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2).
Data Sources: MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost).
Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2).
Pediatr Crit Care Med
February 2023
Objectives: We sought to update our 2015 work in the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PARDS), considering new evidence and topic areas that were not previously addressed.
Design: International consensus conference series involving 52 multidisciplinary international content experts in PARDS and four methodology experts from 15 countries, using consensus conference methodology, and implementation science.
Setting: Not applicable.
Article Synopsis
- - PARDS is a severe lung condition in children that differs from ARDS in adults due to factors like age, lung growth, and underlying health issues, resulting in higher mortality and long-term health problems.
- - There is no specific treatment for PARDS; current management focuses on supportive care, highlighting the need for better strategies to identify who might benefit from targeted interventions like specific ventilation techniques or prone positioning.
- - Improving our understanding of the diverse clinical features of PARDS compared to adult ARDS, and utilizing advanced data analysis techniques, could lead to more personalized and effective treatment approaches in the future.
The Kids Are Not Okay: Healthcare Utilization After Critical Illness.
Pediatr Crit Care Med
April 2022
Background: Mechanical power is a composite variable for energy transmitted to the respiratory system over time that may better capture risk for ventilator-induced lung injury than individual ventilator management components. We sought to evaluate if mechanical ventilation management with a high mechanical power is associated with fewer ventilator-free days (VFD) in children with pediatric acute respiratory distress syndrome (PARDS).
Methods: Retrospective analysis of a prospective observational international cohort study.
Article Synopsis
- The study investigates the relationship between a plasma marker called soluble receptor for advanced glycation end products (sRAGE) and outcomes in pediatric patients with acute respiratory distress syndrome (ARDS), including lung and organ dysfunction, as well as mortality.
- It was conducted in five pediatric intensive care units with a sample of 258 children aged 30 days to 18 years who met certain ARDS criteria, with blood samples taken at various time points for analysis.
- Findings show that while sRAGE levels are linked to more severe lung injury, they also correlate with worse organ dysfunction and higher levels of pro-inflammatory markers, indicating its potential role in predicting outcomes beyond just lung injury.
Objectives: Interventional trials aimed at pediatric acute respiratory distress syndrome prevention require accurate identification of high-risk patients. In this study, we aimed to characterize the frequency and outcomes of children meeting "at risk for pediatric acute respiratory distress syndrome" criteria as defined by the Pediatric Acute Lung Injury Consensus Conference.
Design: Planned substudy of the prospective multicenter, international Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study conducted during 10 nonconsecutive weeks (May 2016-June 2017).
Adherence to Lung-Protective Ventilation Principles in Pediatric Acute Respiratory Distress Syndrome: A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study.
Crit Care Med
October 2021
Objectives: To describe mechanical ventilation management and factors associated with nonadherence to lung-protective ventilation principles in pediatric acute respiratory distress syndrome.
Design: A planned ancillary study to a prospective international observational study. Mechanical ventilation management (every 6 hr measurements) during pediatric acute respiratory distress syndrome days 0-3 was described and compared with Pediatric Acute Lung Injury Consensus Conference tidal volume recommendations (< 7 mL/kg in children with impaired respiratory system compliance, < 9 mL/kg in all other children) and the Acute Respiratory Distress Syndrome Network lower positive end-expiratory pressure/higher Fio2 grid recommendations.