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Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
Published on: April 7, 2021
Nutrition practices and outcomes in patients with pediatric acute respiratory distress syndrome
Matthew B F Powell1, Prakadeshwari Rajapreyar1, Ke Yan2
1Division of Critical Care, Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI, USA.
Insights
Early enteral nutrition (EEN) in pediatric acute respiratory distress syndrome (PARDS) patients significantly reduced mortality and intensive care unit length of stay. This protective effect highlights the importance of timely nutritional support in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Nutritional Support
- Respiratory Medicine
Background:
- Pediatric acute respiratory distress syndrome (PARDS) is a major cause of illness and death in critically ill children.
- Enteral nutrition (EN) shows potential protective benefits for these patients.
Purpose of the Study:
- To investigate the association between early enteral nutrition (EEN) and outcomes in pediatric patients with PARDS.
- To compare mortality, intensive care unit (ICU) length of stay (LOS), and ventilator-free days between patients who received EEN and those who did not.
Main Methods:
- Retrospective cohort study including 151 intubated patients with PARDS (aged 2 weeks to 18 years).
- Patients receiving ≥25% of calculated energy goal enterally within 48 hours of PARDS diagnosis were defined as EEN group.
- Disease severity assessed using oxygenation index (OI), oxygen saturation index (OSI), and pediatric logistic organ dysfunction (PELOD-2) scores.
Main Results:
- The EEN group showed significantly lower pediatric ICU (PICU) mortality rates (aOR = 0.071) and a higher likelihood of PICU discharge (aRR = 1.79).
- Patients receiving EEN had more ventilator-free days (aOR = 3.96) and shorter PICU LOS.
- Adjusted analyses confirmed the association between EEN and improved outcomes, including reduced mortality (P = 0.033) and shorter PICU LOS (P < 0.001).
Conclusions:
- Early enteral nutrition (EEN) is associated with improved outcomes in pediatric acute respiratory distress syndrome (PARDS) patients.
- EEN positively impacts mortality rates, pediatric intensive care unit length of stay, and ventilator-free days.
- These findings underscore the critical role of early nutritional intervention in managing PARDS.
Background:
Pediatric acute respiratory distress syndrome (PARDS) remains a significant cause of morbidity and mortality. Evidence suggests enteral nutrition (EN) may be protective in critically ill children.
Methods:
This is a retrospective cohort study comparing intubated patients with PARDS who received EEN and those who did not. We included patients aged 2 weeks to 18 years who could receive full nutrition enterally prior to their disease and excluded patients with cyanotic heart disease. Disease severity was captured with oxygenation index (OI), oxygen saturation index (OSI), and pediatric logistic organ dysfunction (PELOD-2). EEN was defined as having received ≥25% of the calculated energy goal enterally within the first 48 h of PARDS diagnosis.
Results:
We included 151 patients. Adjusted for age, OI, and OSI, the EEN group had a lower PICU mortality rate (adjusted odds ratio [aOR] = 0.071; 95% CI, 0.009-0.542; P = 0.011), had a higher likelihood of PICU discharge (adjusted risk ratio = 1.79; 95% CI, 1.25-2.55; P = 0.001), and was more likely to have at least one ventilator-free day (aOR = 3.96; 95% CI, 1.28-12.22; P = 0.017). Adjusted for age and PELOD-2, a statistically significant association between the EEN group and lower PICU mortality (P = 0.033), shorter PICU LOS (P < 0.001), and more ventilator-free days (P = 0.037) persisted.
Conclusion:
Our study found that EEN was associated with superior mortality rates, PICU LOS, and ventilator-free days in patients with PARDS.
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