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Acute Kidney Injury in Pediatric Acute Respiratory Distress Syndrome
Shubhi Kaushik1,2, Sindy Villacres3, Ruth Eisenberg2
1Division of Pediatric Critical Care Medicine, 37292Children's Hospital at Montefiore, Bronx, NY, USA.
Insights
Acute kidney injury (AKI) affects 64% of children with acute respiratory distress syndrome (ARDS), leading to longer hospital stays. Early identification of AKI in ARDS patients is crucial for better outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Pulmonology
Background:
- Acute respiratory distress syndrome (ARDS) is a severe lung condition in children.
- Acute kidney injury (AKI) is a common complication in critically ill children.
- The relationship between ARDS and AKI in pediatric populations requires further investigation.
Purpose of the Study:
- To determine the incidence and risk factors of AKI in children with ARDS.
- To evaluate the impact of AKI on patient outcomes, including hospital stay and mortality.
- To identify predictors for AKI in pediatric ARDS patients.
Main Methods:
- A retrospective, single-center study was conducted at a tertiary care children's hospital.
- Included were pediatric patients (<18 years) with ARDS requiring invasive mechanical ventilation (MV) between July 2010 and July 2013.
- AKI was diagnosed using the p-RIFLE criteria.
Main Results:
- Of 115 children with ARDS, 74 (64%) developed AKI.
- AKI was associated with lower Pao2/Fio2 ratio, increased need for inotropes and diuretics, and higher ventilatory support requirements (higher oxygenation index, PEEP, mean airway pressure, Fio2).
- Patients with AKI experienced significantly longer hospital stays but not increased ICU stay, duration of MV, or mortality. A multivariable model predicted AKI with an AUC of 0.75.
Conclusions:
- Pediatric patients with ARDS exhibit a high incidence of AKI.
- The presence of AKI in pediatric ARDS is linked to increased morbidity, particularly prolonged hospitalization.
- Predictive models incorporating ventilatory parameters and clinical factors show promise for early AKI detection in this population.
Objectives:
To describe the incidence of and risk factors for acute kidney injury (AKI) in children with acute respiratory distress syndrome (ARDS) and study the effect of AKI on patient outcomes.
Design:
A single-center retrospective study.
Setting:
A tertiary care children's hospital.
Patients:
All patients less than 18 years of age who received invasive mechanical ventilation (MV) and developed ARDS between July 2010 and July 2013 were included. Acute kidney injury was defined using p-RIFLE (risk, injury, failure, loss, and end-stage renal disease) criteria.
Interventions:
None.
Measurements And Main Results:
One hundred fifteen children met the criteria and were included in the study. Seventy-four children (74/115, 64%) developed AKI. The severity of AKI was risk in 34 (46%) of 74, injury in 19 (26%) of 74, and failure in 21 (28%) of 74. The presence of AKI was associated with lower Pao 2 to Fio 2 (P/F) ratio (P = .007), need for inotropes (P = .003), need for diuretics (P = .004), higher oxygenation index (P = .03), higher positive end-expiratory pressure (PEEP; P = .01), higher mean airway pressure (P = .008), and higher Fio 2 requirement (P = .03). Only PEEP and P/F ratios were significantly associated with AKI in the unadjusted logistic regression model. Patients with AKI had a significantly longer duration of hospital stay, although there was no significant difference in the intensive care unit stay, duration of MV, and mortality. Recovery of AKI occurred in 68% of the patients. A multivariable model including PEEP, P/F ratio, weight, need for inotropes, and need for diuretics had a better receiver operating characteristic (ROC) curve with an AUC of 0.75 compared to the ROC curves for PEEP only and P/F ratio only for the prediction of AKI.
Conclusions:
Patients with ARDS have high rates of AKI, and its presence is associated with increased morbidity and mortality.
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