Randomized Trial of Lung and Diaphragm Protective Ventilation in Children.

Summary

In a single-center, phase II RCT of children with ARDS, a CDS-guided lung- and diaphragm-protective ventilation strategy (with esophageal manometry) shortened the length of ventilator weaning compared with usual care. During patient-triggered breathing, peak inspiratory pressure was lower with the intervention. These findings support progression to a phase III trial.

Key Findings

• CDS-guided lung and diaphragm protective ventilation shortened the weaning length compared with usual care.
• During patient-triggered breaths, peak inspiratory pressure was lower in the intervention arm.
• The protocolized strategy was feasible across acute and weaning phases with daily standardized SBTs.

Clinical Implications

Adopting CDS-guided lung and diaphragm protective ventilation with standardized SBTs may reduce weaning time in pediatric ARDS; training and access to esophageal manometry and CDS tools are prerequisites.

Limitations

• Single-center, phase II study limits generalizability.
• Potential lack of blinding and pediatric-specific context may limit extrapolation to adults.

Future Directions

Conduct multicenter phase III trials to confirm efficacy, evaluate safety, and test implementation strategies, including CDS integration and training.