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Acute respiratory distress syndrome in children: a 10 year experience
1Department of Pediatric Intensive Care, Sheba Medical Center, Tel-Hashomer, Israel. gparet@post.tau.ac.il
Insights
This study found that pediatric acute respiratory distress syndrome (ARDS) has a high mortality rate, comparable to adult outcomes. Key predictors of death in children include low PaO2/FIO2 and high alveolar-arterial O2 difference within two days of diagnosis.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Pulmonary medicine
Background:
- Acute Respiratory Distress Syndrome (ARDS) is a severe condition characterized by high-permeability pulmonary edema and significant morbidity.
- Understanding ARDS in children is crucial due to its high mortality and complex presentation.
Purpose of the Study:
- To analyze a decade of pediatric ARDS cases.
- Identify predisposing factors, clinical course, and mortality predictors in pediatric ARDS.
- Establish a local risk profile for early intervention.
Main Methods:
- Retrospective review of pediatric intensive care unit admissions over 10 years.
- Inclusion criteria for ARDS: acute onset, diffuse bilateral infiltrates (non-cardiac), severe hypoxemia (PaO2/PEEP < 200) for ≥24 hours.
- Data collected: demographics, clinical course, physiological parameters (PaO2/FIO2, A-aDO2, ventilation index).
Main Results:
- 39 pediatric ARDS cases identified; mean age 7.4 years.
- Common predisposing factors: sepsis, pneumonia, malignancy, trauma, shock.
- Mortality rate was 61.5%.
- Second-day predictors of mortality: PaO2/FIO2, ventilation index, and A-aDO2.
- Nonsurvivors showed significantly lower PaO2/FIO2 and higher A-aDO2 and ventilation index compared to survivors.
Conclusions:
- Pediatric ARDS outcomes in this cohort are comparable to international tertiary centers.
- PaO2/FIO2, A-aDO2, and ventilation index are valuable early predictors of outcome in pediatric ARDS.
- Developing a local risk profile can facilitate timely application of novel therapies.
Background:
Acute respiratory distress syndrome is a well-recognized condition resulting in high permeability pulmonary edema associated with a high morbidity.
Objectives:
To examine a 10 year experience of predisposing factors, describe the clinical course, and assess predictors of mortality in children with this syndrome.
Methods:
The medical records of all admissions to the pediatric intensive care unit over a 10 year period were evaluated to identify children with ARDS. Patients were considered to have ARDS if they met all of the following criteria: acute onset of diffuse bilateral pulmonary infiltrates of non-cardiac origin and severe hypoxemia defined by < 200 partial pressure of oxygen during > or = 6 cm H2O positive end-expiratory pressure for a minimum of 24 hours. The medical records were reviewed for demographic, clinical, and physiologic information including PaO2/forced expiratory O2, alveolar-arterial O2 difference, and ventilation index.
Results:
We identified 39 children with the adult respiratory distress syndrome. Mean age was 7.4 years (range 50 days to 16 years) and the male:female ratio was 24:15. Predisposing insults included sepsis, pneumonias, malignancy, major trauma, shock, aspiration, near drowning, burns, and envenomation. The mortality rate was 61.5%. Predictors of death included the PaO2/FIO2, ventilation index and A-aDO2 on the second day after diagnosis. Nonsurvivors had significantly lower PaO2/FIO2 (116 +/- 12 vs. 175 +/- 8.3, P < 0.001), and higher A-aDO2 (368 +/- 28.9 vs. 228.0 +/- 15.5, P < 0.001) and ventilation index (43.3 +/- 2.9 vs. 53.1 +/- 18.0, P < 0.001) than survivors.
Conclusions:
Local mortality outcome for ARDS is comparable to those in tertiary referral institutions in the United States and Western Europe. The PaO2/FIO2, A-aDO2 and ventilation index are valuable for predicting outcome in ARDS by the second day of conventional therapy. The development of a local risk profile may allow early application of innovative therapies in this population.