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Experimental Model to Evaluate Resolution of Pneumonia
Published on: February 17, 2023
Pathogen screening and prognostic factors in children with severe ARDS of pulmonary origin
Thuy Thi Bich Phung1, Tadaki Suzuki2, Phuc Huu Phan3
1Department of Research of Biomolecular for Infectious Disease, Vietnam National Children's Hospital, Hanoi, Vietnam.
Insights
Elevated interferon-gamma (IFN-γ) levels in children with severe Acute Respiratory Distress Syndrome (ARDS) indicate a higher risk of mortality. Modulating inflammatory responses is key for managing pediatric ARDS.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Immunology
Background:
- Acute Respiratory Distress Syndrome (ARDS) is a life-threatening condition in pediatric intensive care units (PICUs).
- Investigating etiological pathogens and prognostic factors in pediatric ARDS secondary to respiratory virus infections is crucial.
Purpose of the Study:
- To prospectively identify pathogens and prognostic factors in children with severe ARDS caused by respiratory virus infections.
- To analyze the association between inflammatory mediators and patient outcomes.
Main Methods:
- Prospective enrollment of children (1 month to 16 years) with infectious pneumonia, respiratory virus infection, and severe ARDS.
- Detection of pathogens in blood and tracheal lavage fluid using molecular and culture techniques.
- Measurement of serum inflammatory mediators on PICU admission.
Main Results:
- Fifty-seven children were enrolled; 60% had multiple viral infections, 49% co-infection with bacteria/fungi.
- Adenovirus-B, measles virus, and cytomegalovirus were predominant in tracheal aspirates.
- Higher serum interferon-gamma (IFN-γ) and IFN-γ/interleukin (IL)-10 ratio in non-survivors compared to survivors.
Conclusions:
- Upregulation of IFN-γ on PICU admission is a potential prognostic factor for fatal outcomes in pediatric ARDS.
- Modulating inflammatory responses is critical for effective clinical management of pediatric ARDS.
Background:
Acute respiratory distress syndrome (ARDS) is one of the most lethal diseases encountered in the pediatric intensive care unit (PICU). The etiological pathogens and prognostic factors of severe ARDS of pulmonary origin in children with respiratory virus infections were prospectively investigated.
Methods:
Enrolled children fulfilled the following criteria: (1) PICU admission; (2) age of 1 month to 16 years; (3) diagnosis of infectious pneumonia and respiratory virus infection; and (4) development of severe ARDS within 72 h after PICU admission. Pathogens were detected in the blood and tracheal lavage fluid using molecular techniques and a conventional culture system. The serum levels of inflammatory mediators on the day of PICU admission were examined.
Results:
Fifty-seven patients (32 boys; median age, 9 months) were enrolled. Multiple virus infections, co-infection with bacteria/fungus, and bacteremia/fungemia were observed in 60%, 49%, and 32% of children, respectively. Adenovirus-B, measles virus, and cytomegalovirus were detected predominantly in tracheal lavage fluid. There were no statistically significant differences between non-survivors and survivors regarding the types of pathogen, incidence of multiple virus infection, gender, age, clinical features, and treatment. The serum levels of interferon (IFN)-γ and the IFN-γ/interleukin (IL)-10 ratio were higher in non-survivors.
Conclusions:
IFN-γ upregulation as detected on the day of PICU admission was found to be one of the possible prognostic factors affecting a fatal outcome. These results suggest that modulation of inflammatory responses is critical for the clinical management of children with ARDS.
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