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Acute Respiratory Distress Syndrome in Children With Lower Respiratory Tract Infection Requiring Invasive Mechanical
Benjamin R White1, Lee Polikoff2, Robin Alexander3
1Department of Pediatrics, Division of Pediatric Critical Care, University of Utah, Salt Lake City, UT.
Insights
Pediatric acute respiratory distress syndrome (PARDS) is common in young children with lower respiratory tract infections, leading to longer ventilation and increased mortality. Further research is needed for optimal critical bronchiolitis management.
Area of Science:
- Pediatric critical care medicine
- Respiratory medicine
- Infectious diseases
Background:
- Lower respiratory tract infections (LRTIs) are a leading cause of pediatric respiratory failure.
- Pediatric acute respiratory distress syndrome (PARDS) in young children with LRTI is not well-characterized, hindering clinical management.
- Understanding PARDS prevalence and characteristics is crucial for improving outcomes in critically ill infants.
Purpose of the Study:
- To determine the prevalence and clinical characteristics of PARDS in young children intubated for LRTI.
- To compare clinical outcomes between children with and without PARDS.
Main Methods:
- Post hoc analysis of the international prospective observational Bronchiolitis And COdetectioN (BACON) study.
- Inclusion of 571 children younger than 2 years requiring mechanical ventilation for acute LRTI across 48 international PICUs.
- Comparison of subjects meeting PARDS criteria on Day 1 post-intubation with those who did not.
Main Results:
- Day 1 PARDS was diagnosed in 42% of subjects (n=240).
- PARDS was associated with significantly increased mortality (7.9% vs. 2.7%), longer invasive ventilation duration (165 hr vs. 135 hr), and longer PICU length of stay (11 days vs. 8 days).
- PARDS presence causally related to prolonged mechanical ventilation, with a lower probability of extubation at 7 days (49% vs. 64%).
Conclusions:
- PARDS is a common and significant complication in critically ill infants with LRTI.
- PARDS development is linked to worse clinical outcomes, including increased mortality and prolonged mechanical ventilation.
- Further prospective research is essential to guide optimal management strategies for critical bronchiolitis and associated PARDS.
Objectives:
Bronchiolitis and other lower respiratory tract infections (LRTIs) are the most common causes of pediatric respiratory failure. There is insufficient evidence characterizing pediatric acute respiratory distress syndrome (PARDS) in young children with LRTI to inform clinical management. We aimed to describe the prevalence and clinical characteristics of children intubated for LRTI and meeting PARDS criteria.
Design:
We performed a post hoc analysis of data from the Bronchiolitis And COdetectioN (BACON) study, an international prospective observational study of critical bronchiolitis. We compared PARDS subjects (meeting criteria the first full calendar day following intubation) to non-PARDS subjects.
Setting:
Forty-eight international PICUs recruiting to the BACON study, from December 2019 to November 2020.
Patients:
Children younger than 2 years old, requiring mechanical ventilation for acute LRTI.
Interventions:
None.
Measurements And Main Results:
Complete data were available for 571 children. Day 1 PARDS was diagnosed in 240 subjects(42%) and associated with increased mortality (7.9% vs. 2.7%; p = 0.023), greater duration of invasive ventilation (165 hr [interquartile range, 112-251 hr] vs. 135 hr [76-204 hr]; p < 0.001), and PICU length of stay (11 d [7-16 d] vs. 8 d [5-13 d]; p < 0.001). In our multivariable competing risk model, the presence of PARDS on day 1 was causally related to a prolonged duration of mechanical ventilation with the probability of extubation at 7 days for those with PARDS equal to 49% (44-54%) compared with 64% (59-69%) for those without PARDS.
Conclusions:
PARDS development was common in this critical bronchiolitis cohort, resulted in a longer duration of mechanical ventilation, and was associated with increased mortality and PICU length of stay. Prospective studies are needed to elucidate the optimal management of critical bronchiolitis.
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