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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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Published on: April 7, 2021

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[Risk factors for mortality in pediatric acute respiratory distress syndrome requiring extracorporeal membrane

H L Zhang1, Z C Feng2, Y Cheng3

  • 1The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China.

Zhonghua Er Ke Za Zhi = Chinese Journal of Pediatrics
|April 26, 2021
PubMed

Insights

Acute kidney injury (AKI) and continuous renal replacement therapy (CRRT) are key risk factors for mortality in pediatric acute respiratory distress syndrome (PARDS) patients on extracorporeal membrane oxygenation (ECMO). Identifying these factors improves patient outcomes.

Area of Science:

  • Pediatric Critical Care Medicine
  • Cardiopulmonary Support
  • Nephrology

Background:

  • Pediatric acute respiratory distress syndrome (PARDS) is a life-threatening condition requiring advanced support.
  • Extracorporeal membrane oxygenation (ECMO) is used for severe PARDS but carries significant mortality risks.
  • Identifying specific risk factors for mortality in PARDS patients on ECMO is crucial for improving survival rates.

Purpose of the Study:

  • To investigate the independent risk factors associated with mortality in children with severe PARDS receiving ECMO support.
  • To analyze demographic, clinical, and laboratory data to identify predictors of death in this vulnerable patient population.

Main Methods:

  • Retrospective analysis of clinical data from 109 pediatric patients with severe PARDS requiring ECMO across 6 Chinese centers (September 2012 - February 2020).
  • Patients were categorized into survival and death groups based on prognosis.
  • Statistical analyses, including Chi-square tests, rank sum tests, and univariate/multivariate Logistic regression, were employed to identify prognostic risk factors.

Main Results:

  • The study included 109 patients, with 54 deaths and 55 survivors.
  • The non-survival group exhibited significantly higher incidences of acute kidney injury (AKI) and coagulation dysfunction compared to the survival group.
  • Multivariate Logistic regression identified AKI and the need for continuous renal replacement therapy (CRRT) as independent risk factors for mortality (HR=4.84 and HR=3.88, respectively).

Conclusions:

  • Acute kidney injury (AKI) is a significant independent risk factor for mortality in pediatric patients with severe PARDS on ECMO.
  • Continuous renal replacement therapy (CRRT), often necessitated by AKI, also independently predicts higher mortality rates in this cohort.
  • These findings underscore the importance of vigilant monitoring and management of renal function and coagulation in critically ill children with PARDS undergoing ECMO.

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