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Published on: April 7, 2021
Risk Stratification in Pediatric Acute Respiratory Distress Syndrome: A Multicenter Observational Study
Judith Ju-Ming Wong1, Huu Phuc Phan, Suwannee Phumeetham
11Children's Intensive Care Unit, Department of Pediatric Subspecialities, KK Women's and Children's Hospital, Singapore. 2Duke-NUS Medical School, Singapore. 3Pediatric Intensive Care Unit, National Children's Hospital, Hanoi, Vietnam. 4Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 5Pediatric Intensive Care Unit, Department of Pediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore. 6Department of Pediatrics, Sarawak General Hospital, Kuching, Malaysia. 7Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, Beijing, China. 8Division of Pediatric Critical Care, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 9Pediatric Department, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 10Department of Pediatrics, University Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia. 11Children's Hospital of Chongqing Medical University, Chongqing, China. 12Center for Quantitative Medicine, Duke-NUS Medical School, Singapore.
Insights
The Pediatric Acute Lung Injury Consensus Conference definition accurately predicts outcomes in pediatric acute respiratory distress syndrome (PARDS). Higher PARDS severity correlates with increased mortality in Asian PICUs.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Epidemiology
Background:
- The Pediatric Acute Lung Injury Consensus Conference (PALICC) established a definition for pediatric acute respiratory distress syndrome (PARDS).
- This definition stratifies PARDS severity into mild, moderate, and severe categories.
- Understanding the epidemiology and outcomes of PARDS in Asia is crucial.
Purpose of the Study:
- To describe the epidemiology of PARDS across Asian pediatric intensive care units (PICUs).
- To evaluate the predictive accuracy of the PALICC severity stratification for patient outcomes.
Main Methods:
- A multicenter, retrospective, descriptive cohort study was conducted.
- Data were collected from 10 multidisciplinary PICUs in Asia.
- Mechanically ventilated children meeting PALICC criteria for PARDS between 2009 and 2015 were included.
Main Results:
- 373 patients with PARDS were analyzed, with 23.9% mild, 39.9% moderate, and 36.2% severe.
- Pneumonia/lower respiratory tract infection was the most common risk factor (82.8%).
- Increased PARDS severity was significantly associated with fewer ventilator-free and PICU-free days, and higher PICU (30.3%) and 100-day (39.7%) mortality rates. Moderate and severe PARDS increased mortality risk (HR 1.88 and 3.18, respectively).
Conclusions:
- PARDS carries a high mortality rate in the Asian population.
- The PALICC definition effectively stratifies risk and predicts outcomes in pediatric patients with ARDS.
Objectives:
The Pediatric Acute Lung Injury Consensus Conference developed a pediatric specific definition for acute respiratory distress syndrome (PARDS). In this definition, severity of lung disease is stratified into mild, moderate, and severe groups. We aim to describe the epidemiology of patients with PARDS across Asia and evaluate whether the Pediatric Acute Lung Injury Consensus Conference risk stratification accurately predicts outcome in PARDS.
Design:
A multicenter, retrospective, descriptive cohort study.
Setting:
Ten multidisciplinary PICUs in Asia.
Patients:
All mechanically ventilated children meeting the Pediatric Acute Lung Injury Consensus Conference criteria for PARDS between 2009 and 2015.
Interventions:
None.
Measurements And Main Results:
Data on epidemiology, ventilation, adjunct therapies, and clinical outcomes were collected. Patients were followed for 100 days post diagnosis of PARDS. A total of 373 patients were included. There were 89 (23.9%), 149 (39.9%), and 135 (36.2%) patients with mild, moderate, and severe PARDS, respectively. The most common risk factor for PARDS was pneumonia/lower respiratory tract infection (309 [82.8%]). Higher category of severity of PARDS was associated with lower ventilator-free days (22 [17-25], 16 [0-23], 6 [0-19]; p < 0.001 for mild, moderate, and severe, respectively) and PICU free days (19 [11-24], 15 [0-22], 5 [0-20]; p < 0.001 for mild, moderate, and severe, respectively). Overall PICU mortality for PARDS was 113 of 373 (30.3%), and 100-day mortality was 126 of 317 (39.7%). After adjusting for site, presence of comorbidities and severity of illness in the multivariate Cox proportional hazard regression model, patients with moderate (hazard ratio, 1.88 [95% CI, 1.03-3.45]; p = 0.039) and severe PARDS (hazard ratio, 3.18 [95% CI, 1.68, 6.02]; p < 0.001) had higher risk of mortality compared with those with mild PARDS.
Conclusions:
Mortality from PARDS is high in Asia. The Pediatric Acute Lung Injury Consensus Conference definition of PARDS is a useful tool for risk stratification.
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