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Risk Factors for Mortality and Outcomes in Pediatric Acute Lung Injury/Acute Respiratory Distress Syndrome
Flávia F Panico1, Eduardo J Troster, Cindy S Oliveira
11Pediatric Intensive Care Unit, Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina, São Paulo University Medical School, São Paulo, Brazil. 2Department of Pediatrics, São Paulo University Medical School, São Paulo, Brazil. 3Pediatric Intensive Care Unit, Albert Einstein Hospital, São Paulo, Brazil. 4Pediatric Intensive Care Unit, Federal University of São Paulo (UNIFESP), São Paulo, Brazil. 5Pediatric Intensive Care Unit, Hospital Pequeno Príncipe, Curitiba, Brazil. 6Dendrix Research, São Paulo, Brazil.
Insights
High mortality occurs in pediatric acute respiratory distress syndrome requiring mechanical ventilation. Key risk factors for death include organ dysfunction and specific ventilator settings, offering targets for intervention.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- Pediatric intensive care units (PICUs) frequently manage children with respiratory failure necessitating mechanical ventilation.
- Identifying risk factors for mortality in this vulnerable population is crucial for improving outcomes.
Purpose of the Study:
- To prospectively identify risk factors associated with mortality in children admitted to PICUs who require mechanical ventilation.
- To analyze the relationship between specific mechanical ventilation parameters and patient outcomes in pediatric acute lung injury/acute respiratory distress syndrome.
Main Methods:
- A prospective, multicenter observational study was conducted in three general PICUs in Brazil.
- Included were children aged 1 month to 15 years with acute lung injury or acute respiratory distress syndrome (ALI/ARDS) requiring mechanical ventilation for at least 12 hours.
- Logistic regression models were used to identify independent variables associated with mortality.
Main Results:
- Of 1,658 patients on mechanical ventilation, 84 met ALI/ARDS criteria. The overall mortality rate was 39.3%.
- Patients with ALI showed no mortality, while 33 of 76 with ARDS died.
- Multivariate analysis revealed that the number of organ dysfunctions at admission, peak inspiratory pressure, airway pressure gradient on day 1, and mean airway pressure gradient over the first 7 days were significantly associated with mortality.
Conclusions:
- Mortality remains high for pediatric patients with acute lung injury/acute respiratory distress syndrome requiring mechanical ventilation.
- Mechanical ventilation-associated risk factors, such as elevated airway pressures and multi-organ dysfunction, represent critical targets for therapeutic interventions to reduce mortality.
Objectives:
Children admitted to PICUs often present with or develop respiratory failure that requires mechanical ventilation. We prospectively identified children admitted to three general PICUs, with the goal of identifying risk factors for mortality.
Design:
Prospective multicenter observational study.
Setting:
Three general PICUs, two in São Paulo and one in Curitiba, Brazil.
Patients:
Children aged between 1 month and 15 years, consecutively admitted between August 2008 and July 2010, with acute lung injury or acute respiratory distress syndrome that developed at least 12 hours after invasive or noninvasive mechanical ventilation.
Interventions:
None.
Measurements And Main Results:
We used logistic regression models to explore the relationship between death and independent variables. Of 3,046 patients admitted to the three PICUs, 1,658 patients underwent mechanical ventilation, and 84 fulfilled the acute lung injury/acute respiratory distress syndrome inclusion criteria and were analyzed. Nearly 60% were boys, and the median age was 31 months. Pressure control/assist control was the initial mode of mechanical ventilation in 86% of cases, and the median durations of mechanical ventilation and PICU stay were 12 and 15 days, respectively. None of the eight patients with acute lung injury died, whereas 33 of 76 of the remaining patients with acute respiratory distress syndrome died, for an overall mortality rate of 39.3% (95% CI, 28.8-50.6%). In different multivariate logistic regression model, the number of organ dysfunctions at admission, peak inspiratory pressure, airway pressure gradient on day 1, and the mean airway pressure gradient over the first 7 days of mechanical ventilation were significantly associated with mortality.
Conclusion:
Mortality is high in pediatric acute lung injury/acute respiratory distress syndrome. Mechanical ventilation-associated risk factors for death among such patients are potential targets for intervention.
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