In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Elizabeth H. Mack, MD, MS, FCCM, speaks with Anil Sachdev, MD, FICCM, of the Institute of Child Health, Sir Ganga Ram Hospital in New Delhi, India about his team’s study, “Transpulmonary Pressure-Guided Mechanical Ventilation in Severe Acute Respiratory Distress Syndrome in the PICU: Single-Center Retrospective Study in North India, 2018–2021,” published in the March 2025 issue of Pediatric Critical Care Medicine.

Dr. Sachdev explains the development and implementation at his institution of a protocol for transpulmonary pressure (TPP) monitoring in pediatric patients with severe acute respiratory distress syndrome. His team compared outcomes of patients receiving TPP-guided ventilation with those receiving conventional mechanical ventilation. Study findings suggested that TPP monitoring enabled the use of higher positive end-expiratory pressure with greater clinician confidence, resulting in improved oxygenation.

Study limitations included small sample size and challenges of equipment availability, cost, and obtaining parental consent. The study was conducted in part during the COVID-19 pandemic, which further constrained resources and study participation.

The discussion concludes with Dr. Sachdev’s insights into practical challenges of TPP monitoring, including inserting delicate esophageal catheters in infants and young children and the necessity of correct catheter position for accurate readings.

Resources referenced in this episode:

Transpulmonary Pressure-Guided Mechanical Ventilation in Severe Acute Respiratory Distress Syndrome in the PICU: Single-Center Retrospective Study in North India, 2018–2021 (Sachdev A, et al. Pediatr Crit Care Med. 2025;26:e354-e363).

SCCMPod-546 PCCM: Finding Better Ventilation Strategies for Pediatric ARDS