Epidemiology, ventilation management, and clinical outcomes in children (PRoVENT-PED): first results from the 10-year, investigator-initiated, international, multicentre, prospective cohort study.

Summary

In a prospective international cohort of 1427 invasively ventilated children across 83 ICUs in 34 countries, PARDS was present in 11% and was most common in preschool-aged children. Overall 28-day ICU mortality was 14%, with higher mortality in PARDS (27%) than non-PARDS (12%), and ventilator management varied by age and PARDS status with younger age and PARDS associated with exposure to higher airway pressures.

Key Findings

• Prospective cohort enrolled 1427 children across 83 ICUs in 34 countries.
• PARDS was identified in 164 children (11%), most frequent in preschool-aged patients.
• 28-day ICU mortality was 14% overall, lowest in neonates (3%) and higher in PARDS than non-PARDS (27% vs 12%).
• Ventilation practices varied by age and PARDS status; younger age and PARDS were associated with exposure to high airway pressures.
• Study registered at ClinicalTrials.gov (NCT06220825).

Clinical Implications

Findings support age-tailored ventilation strategies in children and heightened attention to airway pressure exposure in PARDS. The mortality patterns provide contemporary benchmarks to inform quality improvement and trial design.

Limitations

• Observational design limits causal inference and residual confounding may persist
• Abstract does not provide complete details on associations of specific ventilator variables with outcomes

Future Directions

Define age-specific ventilation targets (e.g., airway pressure thresholds) in interventional trials and explore long-term outcomes beyond 28 days.