Post Extubation Noninvasive Respiratory Support for Pediatric ARDS
Bibliographic record
Abstract
BACKGROUND: Pediatric ARDS (PARDS) survivors may need postextubation noninvasive respiratory support (NRS) via high-flow nasal cannula, CPAP, or noninvasive ventilation (NIV). We hypothesized that NRS use post extubation would vary by region. METHODS: We performed a post-hoc analysis of the Pediatric Acute Respiratory Distress Incidence and Epidemiology (PARDIE) study and compared extubated subjects receiving NRS to those who did not. Logistic regression tested the associations between risk factors and post extubation NRS use. RESULTS: We included 468 surviving subjects (median age: 2.2 [IQR: 0.5-8.7] years) of whom 262 (56%) received postextubation NRS. Subjects treated with NRS postextubation spent more time in the ICU (median: 13.7 [IQR: 8.3-24.5] vs 10.1 [IQR: 6.3-17.6] days, p < 0.01). Increasing age (OR: 0.95, 95% CI: 0.92-0.99), increasing PRISM4 (OR: 0.18, 95% CI: 0.04-0.85), and longer duration of invasive mechanical ventilation (OR: 0.98, 95% CI: 0.96-0.99) were associated with a decreased odds of postextubation NRS use. Being from the North American region (OR: 2.41, 95% CI: 1.26-4.68) compared to Central and South America, immunocompromised (OR: 2.45, 95% CI: 1.09-5.9), and neuromuscular disease (OR: 2.96, 95% CI: 1.51-6.1) were associated with an increased odds of postextubation NRS use. Increased HFNC use was associated with North American region and prior ECMO exposure while age, NRS before intubation, and duration of mechanical ventilation were associated with decreased use. NIV use was associated with European region, Middle East/Asia/New Zealand, neuromuscular disease, and beta agonist use. CONCLUSION: Over half of PARDS subjects received post extubation NRS and type of use varied by region, comorbidities, age, and duration of mechanical ventilation. HFNC was more widely used in North America while NIV was used more in Europe, and the Middle East/Asia/New Zealand.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".