Reliability of Driving Pressure Measurement in Children Receiving Pressure Support Ventilation

Background: Driving pressure (ΔP) is an important predictor of mortality in patients receiving invasive mechanical ventilation and is used to monitor pulmonary mechanical stress. However, its reliability in the pediatric population during patient-triggered ventilation is unclear. This study aimed to evaluate the intra- and inter-examiner reliability of ΔP measurement in children on pressure support ventilation (PSV) mode. Methods: This clinimetric study was conducted in a single-center, tertiary pediatric ICU. Children aged between one month and 17 years, on PSV, were enrolled between February 2022 and December 2023. ΔP measurement was performed by 2 independent evaluators with a one-minute interval using the standard formula (plateau pressure - PEEP). Plateau pressure was obtained by interrupting the flow at the end of inspiration during spontaneous breathing in PSV. Intraclass correlation coefficient (ICC) was used to assess agreement, and Bland-Altman analysis was used to evaluate average bias. Results: Data from 67 subjects, totaling 93 paired assessments, were analyzed. Reliability analysis showed high inter-examiner (A1 × B: ICC = 0.96, A2 × B: ICC = 0.97) and intra-examiner (A1 × A2: ICC = 0.97) agreement, all with P < .001. Average bias between examiners was -0.04 ± 1.16 (A1 × B), 0.02 ± 0.90 (A2 × B), and -0.06 ± 1.01 for repeated measurements by the same examiner. Conclusions: ΔP measurement in children undergoing PSV could be reliably assessed by different examiners. Further studies with larger samples are recommended to validate these findings.