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Acute Hypoxemic Respiratory Failure in Children at the Start of COVID-19 Outbreak: A Nationwide Experience

Yolanda M López-Fernández1, Amelia Martínez-de-Azagra2, José M González-Gómez3

  • 1Pediatric Intensive Care Unit, Hospital Universitario de Cruces, Biocruces-Bizkaia Health Research Institute, 48903 Barakaldo, Spain.

Journal of Clinical Medicine
|October 13, 2021
PubMed

Insights

Children with acute hypoxemic respiratory failure (AHRF) due to SARS-CoV-2 infection had fewer comorbidities and better oxygenation compared to non-COVID-19 AHRF patients. Severe pediatric acute respiratory distress syndrome (PARDS) was uncommon in children with COVID-19.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Medicine
  • Infectious Diseases

Background:

  • Acute hypoxemic respiratory failure (AHRF) in children presents diverse etiologies.
  • Invasive mechanical ventilation (IMV) is a critical intervention for severe AHRF.
  • Comparing outcomes in COVID-19 versus non-COVID-19 related AHRF is essential.

Purpose of the Study:

  • To describe physiological characteristics, respiratory management, and outcomes of pediatric AHRF patients.
  • To compare children with AHRF due to SARS-CoV-2 against those with other etiologies.
  • To analyze the progression to pediatric acute respiratory distress syndrome (PARDS) and mortality rates.

Main Methods:

  • Prospective, multicenter, observational study design.
  • Inclusion of 28 pediatric patients with AHRF requiring IMV.
  • Comparison between 9 COVID-19 patients and 19 non-COVID-19 patients.

Main Results:

  • Non-COVID-19 patients exhibited more comorbidities (78.9% vs. 44.4%).
  • COVID-19 patients demonstrated better initial oxygenation (PaO2/FiO2 = 150 vs. 95 mmHg) and lower PaCO2.
  • Progression to severe PARDS was less frequent in COVID-19 patients; overall PICU mortality was 14.3%.

Conclusions:

  • Children with SARS-CoV-2 AHRF had fewer comorbidities and superior oxygenation compared to non-COVID-19 AHRF.
  • Severe PARDS was rarely observed in pediatric COVID-19 cases.
  • Findings highlight distinct clinical profiles and outcomes in pediatric AHRF based on etiology.
Abstract

Keywords:
acute hypoxemic respiratory failureacute respiratory distress syndromechildrencoronavirus disease 2019mechanical ventilation

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