A Retrospective Analysis of Clinical Manifestations, Management and Outcome of Acute Respiratory Distress Syndrome Associated with Coronavirus Disease-2019 Infection in Children
Mihir Sarkar, Bratesh Das, Manas K Mahapatra, Satyabrata Roychowdhoury, Sambhunath Das, Mithun C Konar
Acute respiratory distress syndrome, Children, Coronavirus disease-2019, Pediatric intensive care unit
Citation Information :
Sarkar M, Das B, Mahapatra MK, Roychowdhoury S, Das S, Konar MC. A Retrospective Analysis of Clinical Manifestations, Management and Outcome of Acute Respiratory Distress Syndrome Associated with Coronavirus Disease-2019 Infection in Children. Indian J Crit Care Med 2022; 26 (3):331-338.
Background: Acute respiratory distress syndrome (ARDS) associated with COVID-19 in children is not well described in the literature, so this study was designed to assess the severity, clinical course, different treatment measures, and outcome of this group of patients.
Patients and methods: This descriptive study was performed by retrospective chart review of children admitted in pediatric intensive care unit (PICU) in the age-group of 1 month to 12 years over the period of 6 months (July–December 2020) in a tertiary care pediatric COVID facility in eastern India. Severity of ARDS, ventilator settings, oxygenation and laboratory parameters, and outcomes were documented. Predictors associated with severe ARDS were evaluated.
Results: Among 128 laboratory-confirmed pediatric COVID-19 cases admitted in PICU, 18 (14%) developed ARDS, 6 (33.3%) had severe ARDS, and 3 (16.6%) succumbed to death. Outcome was measured by median hospital stay [20 days (IQR 19, 21)], PICU stay [13 days (IQR 10, 16)], and 28-day ventilator-free days [14 days (IQR 13, 22)]. Half (n = 9) of our study cohort had different comorbidities and congenital heart disease being the most common (4, 22.2%). Median positive end-expiratory pressure requirement was 10 cm H2O (9, 11) for invasively ventilated children (n = 13, 72.2%) along with peak inspiratory pressure of 24 cm H2O (20, 29) and mean airway pressure of 17 cm H2O (14, 20). Median oxygenation index was 13.3 (10.5, 18.6). Nine (69.2%) out of 13 intubated children had undergone prone ventilation. C-reactive protein (CRP) and D-dimer levels were significantly high in children with severe ARDS alongside pSOFA and lung USG score.
Conclusion: Incidence of ARDS in pediatric COVID-19 though less but is not rare. Elevated CRP, D-dimer values, and high lung USG scores were associated with severe ARDS. Those who died had significant comorbidity.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395(10223):497–506. DOI: 10.1016/S0140-6736(20)30183-5.
Tzotzos SJ, Fischer B, Fischer H, Zeitlinger M. Incidence of ARDS and outcomes in hospitalized patients with COVID-19: a global literature survey. Crit Care 2020;24(1):516. DOI: 10.1186/s13054-020-03240-7.
Dreher M, Kersten A, Bickenbach J, Balfanz P, Hartmann B, Cornelissen C, et al. The characteristics of 50 hospitalized COVID-19 patients with and without ARDS. Dtsch Arztebl Int 2020;117(16): 271–278. DOI: 10.3238/arztebl.2020.0271.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229): 1054–1062. DOI: 10.1016/S0140-6736(20)30566-3.
Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z. Epidemiology of COVID-19 among children in China. Pediatrics 2020;145(6):e20200702. DOI: 10.1542/peds.2020-0702.
Jiang L, Tang K, Levin M, Irfan O, Morris SK, Wilson K, et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis 2020;20(11):e276–e288. DOI: 10.1016/S1473-3099(20)30651-4.
Chao JY, Derespina KR, Herold BC, Goldman DL, Aldrich M, Weingarten J, et al. Clinical characteristics and outcomes of hospitalized and critically ill children and adolescents with coronavirus disease 2019 at a tertiary care medical center in New York City. J Pediatr 2020;223:14–19.e2. DOI: 10.1016/j.jpeds.2020.05.006.
Tsankov BK, Allaire JM, Irvine MA, Lopez AA, Sauvé LJ, Vallance BA, et al. Severe COVID-19 infection and pediatric comorbidities: a systematic review and meta-analysis. Int J Infect Dis 2021;103: 246–256. DOI: 10.1016/j.ijid.2020.11.163.
Li X, Ma X. Acute respiratory failure in COVID-19: is it “typical” ARDS? Crit Care 2020;24(1):198. DOI: 10.1186/s13054-020-02911-9.
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;16:428–439. DOI: 10.1097/PCC.0000000000000350.
Kneyber MCJ, de Luca D, Calderini E, Jarreau PH, Javouhey E, Lopez-Herce J, et al. Section Respiratory Failure of the European Society for Paediatric and Neonatal Intensive Care. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Med 2017;43(12):1764–1780. DOI: 10.1007/s00134-017-4920-z. Epub 2017 Sep 22.
World Health Organization. Pocket book for hospital care of children: guidelines for the management of common illness with limited resources, Geneva. 2013. Available from: https://www.who.int/maternal_child_adolescent/documents/child_hospital_care/en/.
Kellum JA, Lameire N; KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care 2013;17(1):204. DOI: 10.1186/cc11454.
Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med 2020;21(2):e52–e106. DOI: 10.1097/PCC.0000000000002198.
World Health Organization. Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19. Scientific brief. 2020. Available from: https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19.
Webb BJ, Peltan ID, Jensen P, Hoda D, Hunter B, Silver A, et al. Clinical criteria for COVID-19-associated hyperinflammatory syndrome: a cohort study. Lancet Rheumatol 2020;2(12):E764–E773. DOI: 10.1016/S2665-9913(20)30343-X.
Kliegman RM, Geme JS. Nelson textbook of pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020.
Matics TJ, Bubeck-Wardenburg J, Sanchez-Pinto N. 1332: the PSOFA score: a modified sequential organ failure assessment score for pediatric patients. Crit Care Med 2016;44(12):408. DOI: 10.1097/01.ccm.0000510006.49298.fb.
Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012;38: 577–591. DOI: 10.1007/s00134-012-2513-4.
Ji L, Cao C, Gao Y, Zhang W, Xie Y, Duan Y, et al. Prognostic value of bedside lung ultrasound score in patients with COVID-19. Crit Care 2020;24(1):700. DOI: 10.1186/s13054-020-03416-1.
RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 2021;384(8):693–704. DOI: 10.1056/NEJMoa2021436.
Garazzino S, Montagnani C, Donà D, Meini A, Felici E, Vergine G, et al. Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April 2020. Euro Surveill 2020;25(18):2000600. DOI: 10.2807/1560- 7917.ES.2020.25.18.2000600.
Gotzinger F, Santiago-Garcia B, Noguera-Julian A, Lanaspa M, Lancella L, Calò Carducci FI, et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Health 2020;4(9):653–661. DOI: 10.1016/S2352-4642(20)30177-2.
Derespina KR, Kaushik S, Plichta A, Conway EE Jr, Bercow A, Choi J, et al. Clinical manifestations and outcomes of critically ill children and adolescents with coronavirus disease 2019 in New York City [published online ahead of print, 2020 Jul 16]. J Pediatr 2020;226: 55–63.e2. DOI: 10.1016/j.jpeds.2020.07.039.
Prata Barbosa A, Lima Setta F, Dos Santos FR, Lanziotti VS, de Castro REV, de Souza DC, et al. Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter study. J Pediatr (RioJ) 2020;96(5):582–592. DOI: 10.1016/j.jped.2020.07.002.
Shekerdemian LS, Mahmood NR, Wolfe KK, Riggs BJ, Ross CE, McKiernan CA, et al. Characteristics and outcomes of children with Coronavirus Disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr 2020;174(9):868–873. DOI: 10.1001/jamapediatrics.2020.1948.
Swann OV, Holden KA, Turtle L, Fairfield CJ, Seth S, Halpin S, et al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. British Medical Journal 2020;370:m3249. DOI: 10.1136/bmj.m3249.
Musolino AM, Supino MC, Buonsenso D, Ferro V, Valentini P, Magistrelli A, et al. Lung ultrasound in children with COVID-19: preliminary findings. Ultrasound Med Biol 2020;46(8):2094–2098. DOI: 10.1016/j.ultrasmedbio.2020.04.026.