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Acute respiratory distress syndrome in children with malignancy--can we predict outcome?
R Ben-Abraham1, A A Weinbroum, A Augerten
1Department of Anesthesia and Critical Care Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Insights
Early respiratory indicators like peak inspiratory pressure and PEEP can predict survival in pediatric cancer patients with acute respiratory distress syndrome (ARDS). These findings aid in timely interventions for critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Pediatric Oncology
- Respiratory Medicine
Background:
- Acute Respiratory Distress Syndrome (ARDS) poses a significant threat to children with hematologic-oncologic malignancies.
- Identifying early predictors of mortality is crucial for improving outcomes in this vulnerable population.
Purpose of the Study:
- To identify early respiratory parameters that predict mortality in pediatric patients with malignancy and ARDS.
- To establish a basis for early therapeutic interventions in this high-risk group.
Main Methods:
- Retrospective chart review of pediatric patients with malignancy and ARDS requiring mechanical ventilation.
- Analysis of respiratory data, including peak inspiratory pressure, PEEP, ventilation index, PaO(2)/FIO(2), and P(A-a)O(2).
- Evaluation of data from January 1987 to January 1997 in a pediatric intensive care unit.
Main Results:
- Out of 17 identified children, 35.3% survived.
- Sepsis syndrome was prevalent, affecting 70.6% of patients.
- Peak inspiratory pressure, PEEP, and ventilation index distinguished outcomes by day 3.
- Oxygenation efficiency parameters (PaO(2)/FIO(2), P(A-a)O(2)) showed a relationship with outcome from day 8.
Conclusions:
- Early mechanical ventilation parameters (peak inspiratory pressure, PEEP, ventilation index) can predict survival by day 3 in children with malignancy and ARDS.
- These findings support the early application of supportive and nonconventional therapies.
- Timely identification of non-survivors can guide critical care decisions.
Purpose:
The purpose of this study was to delineate early respiratory predictors of mortality in children with hemato-oncology malignancy who developed acute respiratory distress syndrome (ARDS).
Materials And Methods:
We conducted a retrospective chart review of children with malignant and ARDS who needed mechanical ventilation and were admitted to a pediatric intensive care unit from January 1987 to January 1997.
Results:
Seventeen children with ARDS and malignancy aged 10.5 +/- 5.1 years were identified. Six of the 17 children (35.3%) survived. Sepsis syndrome was present in 70.6% of all the children. Peak inspiratory pressure, positive end-expiratory pressure (PEEP), and ventilation index values could distinguish outcome by day 3. A significant relationship between respiratory data and outcome related to efficiency of oxygenation, as determined by PaO(2)/FIO(2) and P(A-a)O(2), was present from day 8 after onset of mechanical ventilation.
Conclusions:
Peak inspiratory pressure, PEEP, and ventilation index values could distinguish survivors from nonsurvivors by day 3. This may assist in early application of supportive nonconventional therapies in children with malignancy and ARDS.