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Published on: April 7, 2021
Multiple Organ Dysfunction in Children Mechanically Ventilated for Acute Respiratory Failure
Scott L Weiss1, Lisa A Asaro, Heidi R Flori
11Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2Department of Cardiology, Boston Children's Hospital, Boston, MA. 3Division of Pediatric Critical Care, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI. 4Division of Critical Care, Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO. 5Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA. 6Department of Pediatrics, Harvard Medical School, Boston, MA. 7School of Nursing, University of Pennsylvania, Philadelphia, PA. 8Critical Care and Cardiovascular Program, Boston Children's Hospital, Boston, MA.
Extrapulmonary organ dysfunction is common in pediatric acute respiratory failure, often occurring with sepsis and significantly increasing mortality risk. Early identification and management are crucial for better outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Pediatric Critical Illness
Background:
- Extrapulmonary organ dysfunction (EPOD) impact in pediatric acute respiratory failure (PARF) is not well understood.
- Sepsis and lung injury severity may influence EPOD and outcomes.
Purpose of the Study:
- Determine EPOD frequency, timing, and risk factors in PARF.
- Assess the independent association of multiple organ dysfunction syndrome (MODS) with PARF outcomes.
Main Methods:
- Secondary analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure trial (2009-2013).
- Included 2,449 children mechanically ventilated for PARF across 31 US academic PICUs.
- Used logistic and proportional hazards regression, accounting for PICU clustering.
Main Results:
- 73% of patients had EPOD; 63% had concurrent MODS (day 0/1), 10% had new MODS (day 2+).
- Sepsis-related lung injury strongly correlated with concurrent MODS (93%).
- Concurrent MODS (aOR 6.54) and new MODS (aOR 3.21) independently predicted 90-day mortality.
Conclusions:
- EPOD is frequent in pediatric acute respiratory failure, often concurrent with respiratory dysfunction, particularly in sepsis.
- Both concurrent and new-onset MODS are significant independent risk factors for mortality in this population.
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