Clinical Course of Pediatric Acute Respiratory Distress Syndrome at Moderate Altitude

Area of Science:

• Pediatric Critical Care Medicine
• Pulmonology
• Altitude Physiology

Background:

• Pediatric acute respiratory distress syndrome (PARDS) epidemiology and outcomes at moderate altitudes require further characterization.
• Understanding PARDS in diverse environments is crucial for global health equity.

Purpose of the Study:

• To describe the epidemiology, clinical features, and outcomes of pediatric acute respiratory distress syndrome (PARDS) in patients residing at moderate altitude.
• To evaluate the predictive value of the Pa/Fi ratio for mortality in PARDS at moderate altitude.

Main Methods:

• Retrospective case series of 88 children diagnosed with PARDS and admitted to the Pediatric Intensive Care Unit (PICU) between March 2009 and March 2014.
• Data collected included demographic information, mechanical ventilation parameters, gas exchange, hemodynamics, and organ dysfunction.
• Analysis of mortality rates based on severity (mild, moderate, severe) and correlation with clinical parameters like serum lactate and positive end-expiratory pressure.

Main Results:

• Bronchiolitis and pneumonia were the leading causes of PARDS.
• The overall mortality rate was 19.5%.
• Mortality varied significantly with severity: 46.7% for severe PARDS (Pa/Fi <100), 11.9% for moderate (Pa/Fi 100-200), and 25% for mild (Pa/Fi 200-300).
• Serum lactate and positive end-expiratory pressure showed a significant relationship with mortality (p = 0.02 and p = 0.0013, respectively).

Conclusions:

• Pediatric acute respiratory distress syndrome patients at moderate altitudes exhibit clinical behavior and mortality rates comparable to those at low altitudes.
• The Pa/Fi ratio demonstrated limited utility in predicting mortality for patients with mild and moderate PARDS.
• Further research may explore alternative biomarkers or predictors for PARDS severity and outcomes at altitude.