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Comparison of Prognostic Factors Between Direct and Indirect Pediatric ARDS
Da Hyun Kim1, Eun Ju Ha1, Seong Jong Park1
1Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Pediatric Acute Respiratory Distress Syndrome (ARDS) subtypes have distinct characteristics. Mechanical ventilation parameters impact mortality in direct ARDS, but not indirect ARDS, suggesting subtype-specific management is crucial.
Area of Science:
- Critical Care Medicine
- Pediatric Pulmonology
- Intensive Care
Background:
- Pediatric Acute Respiratory Distress Syndrome (ARDS) is a complex condition with significant morbidity and mortality.
- This study aimed to differentiate pediatric ARDS based on direct and indirect initial triggers.
- Understanding these subtypes is key to identifying prognostic factors and improving outcomes.
Purpose of the Study:
- To categorize pediatric ARDS into direct and indirect subtypes.
- To identify distinct clinical characteristics and prognostic factors for each subtype.
- To provide evidence for subtype-specific management strategies in pediatric ARDS.
Main Methods:
- A retrospective, observational study was conducted in a single tertiary pediatric medical ICU.
- Included were 162 critically ill pediatric patients (1 month to 18 years) with ARDS requiring mechanical ventilation.
- Data were collected between January 2010 and March 2019.
Main Results:
- 162 patients were analyzed: 128 with direct ARDS and 34 with indirect ARDS.
- Direct ARDS was commonly initiated by pneumonia; indirect ARDS by sepsis.
- Indirect ARDS patients exhibited higher lactate, PRISM III, and pSOFA scores. Mechanical ventilation parameters were critical for direct ARDS mortality, unlike indirect ARDS.
Conclusions:
- Direct and indirect pediatric ARDS present with unique clinical features and prognostic indicators.
- Mechanical ventilation management significantly influences mortality in direct ARDS but not indirect ARDS.
- Subtyping pediatric ARDS is essential for tailored prognostic evaluation and management strategies to enhance patient outcomes.
Background:
Pediatric ARDS is a heterogeneous disease entity with high morbidity and mortality. In this study, we categorized pediatric ARDS by direct and indirect initial triggering events and identified characteristics of survivors and nonsurvivors in these 2 subtypes.
Methods:
This was a single-center, retrospective, observational study that included critically ill subjects with pediatric ARDS (age 1 month to 18 y) who had undergone mechanical ventilation support and had been admitted to our 14-bed, multidisciplinary, tertiary pediatric medical ICU between January 2010 and March 2019.
Results:
A total of 162 subjects with pediatric ARDS were included. The direct ARDS subtype accounted for 128 cases, and 34 cases were classified as indirect ARDS. The most common initiating events were pneumonia and sepsis for direct and indirect ARDS, respectively. Subjects with indirect ARDS had higher serum lactate levels, greater Pediatric Risk of Mortality III (PRISM III) and Pediatric Sequential Organ Failure Assessment (pSOFA) scores than those with direct ARDS (P < .05). Nonsurvivors with the direct subtype had worse mechanical ventilation-related parameters, including [Formula: see text], PEEP, [Formula: see text], peak inspiratory pressure, oxygenation index, and [Formula: see text]/[Formula: see text] ratio than survivors with the direct subtype. The likelihood of mortality rose with the severity of ARDS in association with the direct subtype but not with the indirect subtypes. Among children with indirect ARDS, lactate levels and pSOFA scores were significantly higher among nonsurvivors than survivors.
Conclusions:
Direct and indirect pediatric ARDS had distinct clinical characteristics, especially in terms of prognostic factors. Variables related to mechanical ventilation were significantly associated with mortality among subjects with direct pediatric ARDS, but not among subjects with indirect pediatric ARDS. Thus, this study provides evidence of the potential benefit of categorizing patients with pediatric ARDS by subtype for evaluating prognostic factors and developing adjusted management strategies to improve clinical outcomes.
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