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Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
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Characteristics and trajectory of patients with pediatric acute respiratory distress syndrome

Judith Ju-Ming Wong1,2, Herng Lee Tan1, Siew Wah Lee1,3

  • 1Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore.

Pediatric Pulmonology
|February 5, 2020
PubMed

Insights

Pediatric acute respiratory distress syndrome (PARDS) affects a small percentage of children. While comorbidities don't worsen overall outcomes, pulmonary disease and immunosuppression are linked to more severe PARDS cases.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Medicine
  • Pulmonology

Background:

  • Pediatric acute respiratory distress syndrome (PARDS) is a critical condition in children.
  • The Pediatric Acute Lung Injury Consensus Conference (PALICC) provides a standardized definition for PARDS.
  • Understanding PARDS trajectory and the influence of comorbidities is crucial for patient management.

Purpose of the Study:

  • To delineate the disease course of pediatric patients meeting the PALICC definition of PARDS.
  • To evaluate the impact of chronic comorbidities, specifically pulmonary disease and immunosuppression, on PARDS outcomes.

Main Methods:

  • A prospective study was conducted in a multidisciplinary pediatric intensive care unit (PICU) from November 2017 to October 2019.
  • Included were patients under 21 years meeting the PALICC criteria for PARDS.
  • Clinical data, including comorbidities and mechanical ventilation duration, were analyzed to assess outcomes.

Main Results:

  • Eighty-five out of 1272 PICU admissions (6.7%) met the PARDS criteria.
  • Overall mortality was 14.1%.
  • Comorbidities were not associated with worsened outcomes, but pre-existing pulmonary disease and immunosuppression were linked to severe PARDS, increased ECMO use, and fewer ventilator-free days.

Conclusions:

  • A subset of patients meeting PARDS criteria may have alternative, rapidly reversible causes of hypoxemia.
  • Pre-existing pulmonary disease and immunosuppression are associated with a more severe PARDS course and poorer outcomes.
Abstract

Keywords:
acute lung injuryacute respiratory distress syndromepediatricpediatric intensive care unit

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