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Pediatric Acute Respiratory Distress Syndrome in South African PICUs: A Multisite Point-Prevalence Study
Brenda M Morrow1,2, Eleonora Lozano Ray1,2, Mignon McCulloch1,2
1Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
Insights
Pediatric acute respiratory distress syndrome (pARDS) affects nearly one-third of children in South African PICUs, a significantly higher prevalence than elsewhere. This highlights an urgent need for further investigation into pARDS in this region.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Epidemiology
Background:
- Pediatric acute respiratory distress syndrome (pARDS) is a critical condition in children.
- Understanding the prevalence and characteristics of pARDS in diverse settings is crucial for targeted interventions.
Purpose of the Study:
- To determine the prevalence of pediatric acute respiratory distress syndrome (pARDS).
- To describe the clinical characteristics of children diagnosed with pARDS in South African Pediatric Intensive Care Units (PICUs).
Main Methods:
- An observational, multicenter, cross-sectional point-prevalence study was conducted.
- Data were collected from eight PICUs across four South African provinces over six months in 2022.
- The 2015 Pediatric Acute Lung Injury Consensus Conference criteria were used to identify pARDS cases.
Main Results:
- The study identified a pARDS prevalence of 30.6% among 310 pediatric patients.
- Patients with pARDS had a higher risk of mortality compared to those without (5.6% vs 3.9%).
- Increased admission risk of mortality and respiratory conditions were independently associated with pARDS.
Conclusions:
- The prevalence of pARDS in South Africa (30.6%) is notably higher than in other regions.
- This finding underscores the necessity for expanded research on pARDS within the South African context.
Objectives:
To describe the prevalence of pediatric acute respiratory distress syndrome (pARDS) and the characteristics of children with pARDS in South African PICUs.
Design:
Observational multicenter, cross-sectional point-prevalence study.
Setting:
Eight PICUs in four South African provinces.
Patients:
All children beyond the neonatal period and under 18 years of age admitted to participating PICUs.
Interventions:
None.
Measurements And Main Results:
Clinical and demographic data were prospectively collected on a single day of each month, from February to July 2022, using a centralized database. Cases with or at risk of pARDS were identified using the 2015 Pediatric Acute Lung Injury Consensus Conference criteria. Prevalence was calculated as the number of children meeting pARDS criteria/the total number of children admitted to PICU at the same time points. Three hundred ten patients were present in the PICU on study days: 166 (53.5%) male, median (interquartile range [IQR]) age 9.8 (3.1-32.9) months, and 195 (62.9%) invasively mechanically ventilated. Seventy-one (22.9%) patients were classified as being "at risk" of pARDS and 95 patients (prevalence 30.6%; 95% CI, 24.7-37.5%) fulfilled pARDS case criteria, with severity classified as mild (58.2%), moderate (25.3%), and severe (17.6%). Median (IQR) admission Pediatric Index of Mortality 3 risk of mortality in patients with and without pARDS was 5.6 (3.4-12.1) % versus 3.9 (1.0-8.2) % ( p = 0.002). Diagnostic categories differed between pARDS and non-pARDS groups ( p = 0.002), with no difference in age, sex, or presence of comorbidities. On multivariable logistic regression, increasing admission risk of mortality (adjusted odds ratio [aOR] 1.02; 95% CI, 1.00-1.04; p = 0.04) and being admitted with a respiratory condition (aOR 2.64; 95% CI, 1.27-5.48; p = 0.01) were independently associated with an increased likelihood of having pARDS.
Conclusions:
The 30.6% prevalence of pARDS in South Africa is substantially higher than reports from other sociogeographical regions, highlighting the need for further research in this setting.
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