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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
PRISM III Score Predicts Short-Term Outcome in Children with ARDS on Conventional and High-Frequency Oscillatory
Snezana Rsovac1,2, Davor Plavec3,4, Dusan Todorovic5
1Department of Pediatric and Neonatal Intensive Care, University Children's Hospital, Tirsova 10, 11000 Belgrade, Serbia.
Insights
The Pediatric Risk of Mortality (PRISM) III score can predict short-term outcomes in children with pediatric acute respiratory distress syndrome (PARDS) on mechanical ventilation (MV). Higher PRISM III scores indicate a poorer prognosis, regardless of ventilation mode.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Pediatric Intensive Care
Background:
- Pediatric acute respiratory distress syndrome (PARDS) management involves conventional (CMV) and high-frequency oscillatory ventilation (HFOV).
- Predicting short-term outcomes in pediatric patients with PARDS is crucial for timely intervention.
- The Pediatric Risk of Mortality (PRISM) III score is a validated tool for assessing critically ill children.
Purpose of the Study:
- To evaluate the PRISM III score as a predictor of short-term outcomes in mechanically ventilated children with PARDS.
- To assess the prognostic value of PRISM III in relation to mortality and complications within 28 days.
- To explore the relationship between PRISM III scores and specific clinical factors like ventilation mode, sepsis, and shock.
Main Methods:
- Retrospective five-year study in a Pediatric ICU involving 70 children with PARDS on mechanical ventilation.
- Patients were stratified into two age groups: <1 year and 1-7 years.
- PRISM III scores were analyzed to correlate with 28-day outcomes, including mortality and complications, and ventilation strategies (CMV vs. HFOV).
Main Results:
- Pneumonia and sepsis were the most frequent causes of PARDS.
- Male sex, malnutrition, sepsis, and shock were associated with poorer outcomes.
- Higher PRISM III scores significantly correlated with mortality and the need for HFOV, demonstrating prognostic value.
- Sepsis and cardiovascular insufficiency were linked to significantly higher PRISM III scores.
- No significant difference in outcomes was observed between CMV and HFOV.
Conclusions:
- The PRISM III score serves as a fair predictor of 28-day outcomes in pediatric patients with PARDS requiring mechanical ventilation.
- The score's prognostic utility is independent of the mechanical ventilation mode used (CMV or HFOV).
- Identifying high-risk patients through PRISM III can aid in optimizing care strategies for PARDS.
Abstract:
Therapeutic recommendations for pediatric acute respiratory distress syndrome (PARDS) include conventional (CMV) and rescue high-frequency oscillatory mode (HFOV) of mechanical ventilation (MV). The pediatric risk of mortality (PRISM) is a frequently used mortality score for critically ill patients. In search of methods to recognize those patients, we analyzed the PRISM III score as a potential predictor of the short-term outcome in MV subjects with PARDS. A retrospective five-year study of PARDS in children on MV was conducted in the Pediatric ICU. Seventy patients were divided into two groups (age group <1 year and age group 1−7 years). The PRISM III score was used to assess the 28-day outcome and possible development of complications. The most common causes of PARDS were pneumonia and sepsis. Male sex, malnourishment, sepsis, and shock were significant indicators of poor outcome. The PRISM III score values were significantly higher in those who died, as well as in subjects requiring HFOV. The score had a significant prognostic value for short-term mortality. There was no significant difference in outcome based on the comparison of two modes of ventilation. A significantly higher score was noted in subjects who developed sepsis and cardiovascular insufficiency. The PRISM III score is a fair outcome predictor during the 28-day follow-up in MV subjects with PARDS, regardless of the ventilation mode.
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