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VOLUME 26 , ISSUE 8 ( August, 2022 ) > List of Articles

PAEDIATRIC CRITICAL CARE

Epidemiology of Acute Respiratory Distress Syndrome in Pediatric Intensive Care Unit: Single-center Experience

Chandrakant G Pujari, AV Lalitha, Ananya Kavilapurapu

Keywords : Acute hypoxemic respiratory failure, Acute respiratory distress syndrome, Mortality, Pediatric risk of mortality III score

Citation Information : Pujari CG, Lalitha A, Kavilapurapu A. Epidemiology of Acute Respiratory Distress Syndrome in Pediatric Intensive Care Unit: Single-center Experience. Indian J Crit Care Med 2022; 26 (8):949-955.

DOI: 10.5005/jp-journals-10071-24285

License: CC BY-NC 4.0

Published Online: 30-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Acute respiratory distress syndrome (ARDS) is characterized by dysregulated inflammation resulting in hypoxemia and respiratory failure and causes both morbidity and mortality. Objectives: To describe the clinical profile, outcome, and predictors of mortality in ARDS in children admitted to the Pediatric intensive care unit. Materials and methods: This is a single-center retrospective study conducted at a tertiary referral hospital in a 12-bed PICU involving children (1 month to 18 years) with ARDS as defined by Pediatric Acute Lung Injury Consensus Conference (PALICC) guidelines, over a period of 5 years (2016–2020). Demographic, clinical, and laboratory details at onset and during PICU stay were collected. Predictors of mortality were compared between survivors and non-survivors. Results: We identified 89 patients with ARDS. The median age at presentation was 76 months (12–124 months). The most common precipitating factor was pneumonia (66%). The majority of children (35.9%) had moderate ARDS. Overall mortality was 33% with more than half belonging to severe ARDS group (58%). On Kaplan–Meier survival curve analysis, the mean time to death was shorter in the severe ARDS group as compared to other groups. Multiorgan dysfunction was present in 46 (51.6%) of the cases. Non-survivors had higher mean pediatric logistic organ dysfunction (PELOD2) on day 1. PRISM III at admission, worsening trends of ventilator and oxygenation parameters (OI, P/F, MAP, and PEEP) independently predicted mortality after multivariate analysis. Conclusion: High PRISM score predicts poor outcome, and worsening trends of ventilator and oxygenation parameters (OI, P/F, MAP, and PEEP) are associated with mortality.


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  1. Sapru A, Flori H, Quasney MW, et al. Pathobiology of acute respiratory distress syndrome. Pediatr Crit Care Med 2015;16(5 Suppl 1):S6–S22. DOI: 10.1097/PCC.0000000000000431.
  2. Meduri GU, Annane D, Chrousos GP, Marik PE, Sinclair SE. Activation and regulation of systemic inflammation in ARDS: rationale for prolonged glucocorticoid therapy. Chest 2009;136(6):1631–1643. DOI: 10.1378/chest.08-2408.
  3. Gupta S, Sankar J, Lodha R, Kabra SK. Comparison of prevalence and outcomes of pediatric acute respiratory distress syndrome using Pediatric Acute Lung Injury Consensus Conference Criteria and Berlin Definition. Front Pediatr 2018;6:93. DOI: 10.3389/fped.2018.00093.
  4. Tamburro RF, Kneyber MCJ, Pediatric Acute Lung Injury Consensus Conference Group. Pulmonary specific ancillary treatment for pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015;16(5 Suppl 1):S61–S72. DOI: 10.1097/PCC.0000000000000434.
  5. The Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015;16(5):428–439. DOI: 10.1097/PCC.0000000000000350.
  6. Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated pediatric risk of mortality score. Crit Care Med 1996;24(5): 743–752. DOI: 10.1097/00003246-199605000-00004.
  7. Leteurtre S, Duhamel A, Salleron J, Grandbastein B, Lacroix J, Leclerc F, et al. PELOD-2: an update of the pediatric logistic organ dysfunction score. Crit Care Med 2013;41(7):1761–1773. DOI: 10.1097/CCM.0b013e31828a2bbd.
  8. Villar J, Ferrando C, Martínez D, Ambrós A, Muñoz T, Soler JA, et al. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med 2020;8(3):267–276. DOI: 10.1016/S2213-2600(19)30417-5.
  9. Drago BB, Kimura D, Rovnaghi CR, Schwingshackl A, Rayburn M, Meduri GU, et al. Double-blind, placebo-controlled pilot randomized trial of methylprednisolone infusion in pediatric acute respiratory distress syndrome. Pediatr Crit Care Med 2015;16(3):e74–e81. DOI: 10.1097/PCC.0000000000000349.
  10. Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005;6(1):2–8. DOI: 10.1097/01.PCC.0000149131.72248.E6.
  11. Yehya N, Harhay MO, Curley MAQ, Schoenfeld DA, Reeder RW. Reappraisal of ventilator-free days in critical care research. Am J Respir Crit Care Med 2019;200(7):828–836. DOI: 10.1164/rccm.201810-2050CP.
  12. Bhadade RR, de Souza RA, Harde MJ, Khot A. Clinical characteristics and outcomes of patients with acute lung injury and ARDS. J Postgrad Med 2011;57(4):286–290. DOI: 10.4103/0022-3859.90077.
  13. Parvathaneni K, Belani S, Leung D, Newth CJ, Khemani RG. Evaluating the performance of the pediatric acute lung injury consensus conference definition of acute respiratory distress syndrome. Pediatr Crit Care Med 2017;18(1):17–25. DOI: 10.1097/PCC.0000000000000945.
  14. López-Fernández Y, Martínez-de Azagra A, de la Oliva P, Modesto V, Sánchez JI, Parrilla J, et al. Pediatric Acute Lung Injury Epidemiology and Natural History study: incidence and outcome of the acute respiratory distress syndrome in children. Crit Care Med 2012;40(12):3238–3245. DOI: 10.1097/CCM.0b013e318260caa3.
  15. Wong JJ-M, Loh TF, Testoni D, Yeo JG, Mok YH, Lee JH. Epidemiology of pediatric acute respiratory distress syndrome in Singapore: risk factors and predictive respiratory indices for mortality. Front Pediatr 2014;2:78. DOI: 10.3389/fped.2014.00078.
  16. Yadav B, Bansal A, Jayashree M. Clinical profile and predictors of outcome of pediatric acute respiratory distress syndrome in a PICU: a prospective observational study. Pediatr Crit Care Med 2019;20(6):e263–e273. DOI: 10.1097/PCC.0000000000001924.
  17. Singh G, Gladdy G, Chandy TT, Sen N. Incidence and outcome of acute lung injury and acute respiratory distress syndrome in the surgical intensive care unit. Indian J Crit Care Med 2014;18(10):659–665. DOI: 10.4103/0972-5229.142175.
  18. Flori HR, Glidden DV, Rutherford GW, Matthay MA. Pediatric acute lung injury: prospective evaluation of risk factors associated with mortality. Am J Respir Crit Care Med 2005;171(9):995–1001. DOI: 10.1164/rccm.200404-544OC.
  19. Erickson S, Schibler A, Numa A, Nuthall G, Yung M, Pascoe E, et al. Paediatric Study Group; Australian and New Zealand Intensive Care Society. Acute lung injury in pediatric intensive care in Australia and New Zealand: a prospective, multicenter, observational study. Pediatr Crit Care Med 2007;8(4):317–323. DOI: 10.1097/01.PCC.0000269408.64179.FF.
  20. Santschi M, Jouvet P, Leclerc F, Gauvin F, Newth CJ, Carroll CL, et al. Acute lung injury in children: therapeutic practice and feasibility of international clinical trials. Pediatr Crit Care Med 2010;11(6):681–689. DOI: 10.1097/PCC.0b013e3181d904c0.
  21. Bellani G, Laffey JG, Pham T, Madotto F, Fan E, Brochard L, et al. Noninvasive ventilation of patients with acute respiratory distress syndrome. Insights from the LUNG SAFE Study. Am J Respir Crit Care Med 2017;195(1):67–77. DOI: 10.1164/rccm.201606-1306OC.
  22. Khemani RG, Smith L, Lopez-Fernandez YM, Kwok J, Morzov R, Klein MJ, et al. Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. Lancet Respir Med 2019;7(2):115–128. DOI: 10.1016/S2213-2600(18)30344-8.
  23. Khilnani P, Pao M, Singhal D, Jain R, Bakshi A, Uttam R. Effect of low tidal volumes vs conventional tidal volumes on outcomes of acute respiratory distress syndrome in critically ill children. Indian J Crit Care Med 2005;9(4):195. DOI: 10.4103/0972-5229.19758.
  24. Wong JJ-M, Jit M, Sultana R, Mok YH, Yeo JG, Koh JWJC, et al. Mortality in pediatric acute respiratory distress syndrome: a systematic review and meta-analysis. J Intens Care Med 2019;34(7):563–571. DOI: 10.1177/0885066617705109.
  25. Dowell JC, Parvathaneni K, Thomas NJ, Khemani RG, Yehya N. Epidemiology of cause of death in pediatric acute respiratory distress syndrome. Crit Care Med 2018;46(11):1811–1819. DOI: 10.1097/CCM.0000000000003371.
  26. Yehya N, Harhay MO, Klein MJ, Shein SL, Piñeres-Olave BE, Izquierdo L, et al. Predicting mortality in children with pediatric acute respiratory distress syndrome: a pediatric acute respiratory distress syndrome incidence and epidemiology study. Crit Care Med 2020;48(6): e514–e522. DOI: 10.1097/CCM.0000000000004345.
  27. Trachsel D, McCrindle BW, Nakagawa S, Bohn D. Oxygenation index predicts outcome in children with acute hypoxemic respiratory failure. Am J Respir Crit Care Med 2005;172(2):206–211. DOI: 10.1164/rccm.200405-625OC.
  28. Prasertsan P, Anuntaseree W, Ruangnapa K, Saelim K, Geater A. Severity and mortality predictors of pediatric acute respiratory distress syndrome according to the Pediatric Acute Lung Injury Consensus Conference Definition. Pediatr Crit Care Med 2019;20(10):e464–e472. DOI: 10.1097/PCC.0000000000002055.
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