{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T12:58:51Z","timestamp":1790859531057,"version":"4.1.0"},"reference-count":30,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Care"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Respiratory system driving pressure (\u0394P) reflects the combined mechanics of the lung and chest wall and may not represent the distending pressure transmitted specifically to the lung. Transpulmonary driving pressure (\u0394P\n                      <jats:sub>L<\/jats:sub>\n                      ) offers a lung-specific estimate of cyclic mechanical stress, while end-expiratory transpulmonary pressure (P\n                      <jats:sub>L,<\/jats:sub>\n                      <jats:sub>EE<\/jats:sub>\n                      ) may indicate end-expiratory lung stability. We evaluated the associations of \u0394P\n                      <jats:sub>L<\/jats:sub>\n                      and P\n                      <jats:sub>L,<\/jats:sub>\n                      <jats:sub>EE<\/jats:sub>\n                      with 28-day mortality in pediatric ARDS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      This retrospective, multi-center cohort study included invasively ventilated children with ARDS treated in 5 tertiary pediatric ICUs between January 2019 and February 2025. Respiratory mechanics, esophageal pressure, ventilator variables, and arterial blood gases were collected during the first valid assessment within 24 h of ARDS diagnosis. The primary outcome was 28-day mortality. Logistic regression models were used to evaluate the associations between \u0394P\n                      <jats:sub>L<\/jats:sub>\n                      and P\n                      <jats:sub>L,<\/jats:sub>\n                      <jats:sub>EE<\/jats:sub>\n                      and mortality. Youden-derived thresholds were applied to explore transpulmonary pressure phenotypes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among 154 subjects, 29 (18.8%) died within 28\u2009days. Nonsurvivors had higher \u0394P\n                      <jats:sub>L<\/jats:sub>\n                      , lower P\n                      <jats:sub>L,<\/jats:sub>\n                      <jats:sub>EE<\/jats:sub>\n                      , lower lung compliance, higher lung elastance, and higher predicted body weight\u2013normalized mechanical power than survivors. \u0394P\n                      <jats:sub>L<\/jats:sub>\n                      was independently associated with 28-day mortality after adjustment for age, sex, ARDS severity, and Pediatric Logistic Organ Dysfunction-2 score (adjusted odds ratio [OR] = 1.47 per 1\u2009cm H\n                      <jats:sub>2<\/jats:sub>\n                      O increase, 95% CI: 1.19\u20131.81,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001; area under the curve [AUC] = 0.759). Lower P\n                      <jats:sub>L,<\/jats:sub>\n                      <jats:sub>EE<\/jats:sub>\n                      was also independently associated with mortality (adjusted OR = 0.48 per 1\u2009cm H\n                      <jats:sub>2<\/jats:sub>\n                      O increase, 95% CI: 0.32\u20130.72,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001; AUC = 0.744). Exploratory thresholds were \u0394P\n                      <jats:sub>L<\/jats:sub>\n                      \u226511.9\u2009cm H\n                      <jats:sub>2<\/jats:sub>\n                      O and P\n                      <jats:sub>L,<\/jats:sub>\n                      <jats:sub>EE<\/jats:sub>\n                      \u22640.8\u2009cm H\n                      <jats:sub>2<\/jats:sub>\n                      O. Mortality increased across phenotypes, from 8.4% in subjects with low \u0394P\n                      <jats:sub>L<\/jats:sub>\n                      \/preserved P\n                      <jats:sub>L,<\/jats:sub>\n                      <jats:sub>EE<\/jats:sub>\n                      to 54.2% in those with high \u0394P\n                      <jats:sub>L<\/jats:sub>\n                      \/low P\n                      <jats:sub>L,<\/jats:sub>\n                      <jats:sub>EE<\/jats:sub>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      In children with ARDS, higher \u0394P\n                      <jats:sub>L<\/jats:sub>\n                      was independently associated with 28-day mortality. Lower P\n                      <jats:sub>L,<\/jats:sub>\n                      <jats:sub>EE<\/jats:sub>\n                      provided complementary prognostic information, and the combination of elevated \u0394P\n                      <jats:sub>L<\/jats:sub>\n                      and reduced P\n                      <jats:sub>L,<\/jats:sub>\n                      <jats:sub>EE<\/jats:sub>\n                      suggested a high-risk mechanical profile. Prospective validation of these exploratory thresholds is required before clinical implementation.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19433654261476554","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T09:41:51Z","timestamp":1788860511000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Transpulmonary Driving Pressure, End-Expiratory Transpulmonary Pressure, and Mortality in Pediatric ARDS"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2626-5499","authenticated-orcid":false,"given":"Ekin","family":"Soydan","sequence":"first","affiliation":[{"name":"Dr. Soydan and Drs. Demirel and Aslan are affiliated with the Pediatric Intensive Care Unit, Ayd\u0131n City Hospital, Aydin, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozlem","family":"Demirel","sequence":"additional","affiliation":[{"name":"Dr. Soydan and Drs. Demirel and Aslan are affiliated with the Pediatric Intensive Care Unit, Ayd\u0131n City Hospital, Aydin, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaan","family":"Aslan","sequence":"additional","affiliation":[{"name":"Dr. Soydan and Drs. Demirel and Aslan are affiliated with the Pediatric Intensive Care Unit, Ayd\u0131n City Hospital, Aydin, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gulhan","family":"Atakul","sequence":"additional","affiliation":[{"name":"Drs. Atakul, Sara\u00e7, Karaarslan, Agin, Ceylan, and Celik are affiliated with the Pediatric Intensive Care Unit, Dr. Behcet Uz Children\u2019s Hospital, of Health Sciences, Izmir, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sevgi","family":"Topal","sequence":"additional","affiliation":[{"name":"Dr. Topal is affiliated with the Pediatric Intensive Care Unit, Acibadem Altunizade Hospital, Acibadem University, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Colak","sequence":"additional","affiliation":[{"name":"Dr. Colak is affiliated with the Pediatric Intensive Care Unit, Cam Sakura Research and Training Hospital, University of Health Sciences, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozlem","family":"Sarac","sequence":"additional","affiliation":[{"name":"Drs. Atakul, Sara\u00e7, Karaarslan, Agin, Ceylan, and Celik are affiliated with the Pediatric Intensive Care Unit, Dr. Behcet Uz Children\u2019s Hospital, of Health Sciences, Izmir, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferhat","family":"Sari","sequence":"additional","affiliation":[{"name":"Dr. Sar\u0131 is affiliated with the Pediatric Intensive Care Unit, Istanbul Aydin University, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2208-5549","authenticated-orcid":false,"given":"Selcuk Sinan","family":"Celik","sequence":"additional","affiliation":[{"name":"Drs. Atakul, Sara\u00e7, Karaarslan, Agin, Ceylan, and Celik are affiliated with the Pediatric Intensive Care Unit, Dr. Behcet Uz Children\u2019s Hospital, of Health Sciences, Izmir, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Utku","family":"Karaarslan","sequence":"additional","affiliation":[{"name":"Drs. Atakul, Sara\u00e7, Karaarslan, Agin, Ceylan, and Celik are affiliated with the Pediatric Intensive Care Unit, Dr. Behcet Uz Children\u2019s Hospital, of Health Sciences, Izmir, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasan","family":"Agin","sequence":"additional","affiliation":[{"name":"Drs. Atakul, Sara\u00e7, Karaarslan, Agin, Ceylan, and Celik are affiliated with the Pediatric Intensive Care Unit, Dr. Behcet Uz Children\u2019s Hospital, of Health Sciences, Izmir, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gokhan","family":"Ceylan","sequence":"additional","affiliation":[{"name":"Drs. Atakul, Sara\u00e7, Karaarslan, Agin, Ceylan, and Celik are affiliated with the Pediatric Intensive Care Unit, Dr. Behcet Uz Children\u2019s Hospital, of Health Sciences, Izmir, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000350"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003147"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1208707"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-017-1750-x"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-016-0113-0"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.4103\/jpcc.jpcc_48_23"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-016-4400-x"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201312-2193CI"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1410639"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000002848"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-016-1446-7"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0326060"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/thorax-2021-218538"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0708638"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.0555"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003627"},{"key":"e_1_3_2_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_3_2_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.281053"},{"key":"e_1_3_2_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000001224"},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.05685"},{"key":"e_1_3_2_22_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e318247f6cc"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-019-05636-8"},{"key":"e_1_3_2_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2019.11.001"},{"key":"e_1_3_2_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chstcc.2025.100162"},{"key":"e_1_3_2_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e31829760cf"},{"key":"e_1_3_2_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31828a2bbd"},{"key":"e_1_3_2_28_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2024.1293639"},{"key":"e_1_3_2_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000006839"},{"key":"e_1_3_2_30_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201709-1806OC"},{"key":"e_1_3_2_31_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202005-1556OC"}],"updated-by":[{"DOI":"10.1177\/19433654261495894","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000}}],"container-title":["Respiratory Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19433654261476554","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/19433654261476554","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19433654261476554","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T11:56:37Z","timestamp":1790855797000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/19433654261476554"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,8]]},"references-count":30,"alternative-id":["10.1177\/19433654261476554"],"URL":"https:\/\/doi.org\/10.1177\/19433654261476554","relation":{},"ISSN":["1943-3654","1943-3654"],"issn-type":[{"value":"1943-3654","type":"print"},{"value":"1943-3654","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,8]]},"article-number":"19433654261476554"}}