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The Prevalence and Outcome of Acute Hypoxemic Respiratory Failure (PANDORA) Study in Mechanically Ventilated
Yolanda M López-Fernández1, Amelia Martínez-de-Azagra2, Susana B Reyes-Domínguez3
1Pediatric Intensive Care Unit, Department of Pediatrics, Cruces University Hospital, Biocruces-Bizkaia Health Research Institute, Bizkaia, Spain.
Insights
Pediatric acute respiratory distress syndrome (PARDS) affects over half of children with acute hypoxemic respiratory failure (AHRF) requiring invasive mechanical ventilation. PARDS significantly increases mortality risk in these critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Epidemiology
Background:
- Acute hypoxemic respiratory failure (AHRF) and pediatric acute respiratory distress syndrome (PARDS) are critical conditions in children.
- Understanding the epidemiology and outcomes of AHRF and PARDS is crucial for improving patient care.
Purpose of the Study:
- To determine the prevalence of AHRF and PARDS in children requiring invasive mechanical ventilation (IMV).
- To describe the outcomes, including mortality rates, associated with AHRF and PARDS in a pediatric intensive care unit (PICU) population.
Main Methods:
- A prospective, observational study was conducted across 22 PICUs in Spain from October 2019 to September 2021.
- Consecutive children aged 7 days to 15 years diagnosed with AHRF (PaO2/FiO2 ≤ 300 mmHg) requiring IMV with specific PEEP and FiO2 settings were included.
- Data on AHRF prevalence, IMV-PARDS prevalence, and adjunctive therapy use were collected. Outcomes included PICU mortality and ventilator-free days.
Main Results:
- AHRF was diagnosed in 2.8% of PICU admissions requiring IMV.
- Of those with AHRF, 50.3% met the criteria for PARDS.
- PICU mortality was significantly higher in patients with PARDS (30.8%) compared to those with AHRF without PARDS (14.4%). Patients with PARDS also had fewer ventilator-free days.
Conclusions:
- The prevalence of AHRF in this pediatric intensive care population is significant, with PARDS being a common complication.
- PARDS is associated with a substantially increased risk of mortality in children with AHRF.
- These findings highlight the severity of PARDS and the need for effective management strategies in pediatric critical care.
Objectives:
To describe the epidemiology and outcome of children with acute hypoxemic respiratory failure (AHRF) and/or pediatric acute respiratory distress syndrome (PARDS).
Design:
Prospective, observational study in six nonconsecutive 2-month blocks form October 2019 to September 2021.
Setting:
A network of 22 PICUs in Spain.
Patients:
Consecutive children (7 d to 15 yr old) with a diagnosis of AHRF, defined by Pa o2 /F io2 ratio less than or equal to 300 mm Hg, who needed invasive mechanical ventilation (IMV) using positive end-expiratory pressure (PEEP) greater than or equal to 5 cm H 2 O and F io2 greater than or equal to 0.3.
Interventions:
None.
Measurements And Main Results:
The primary outcomes were AHRF prevalence and PICU mortality. The secondary outcomes were the prevalence of IMV with PARDS (IMV-PARDS) and the use of adjunctive therapies. There were 6545 PICU admissions: 1374 (21%) underwent IMV and 181 (2.8%) had AHRF. Ninety-one patients (1.4% of PICU admissions, 6.6% of IMV cases, and 50.3% of AHRF cases) met the Second Pediatric Acute Lung Injury Consensus Conference IMV-PARDS criteria. At baseline, mean (± sd ) tidal volume was 7.4 ± 1.8 mL/kg ideal body weight, PEEP 8.4 ± 3.1 cm H 2 O, F io2 0.68 ± 0.23, and plateau pressure 25.7 ± 6.3 cm H 2 O. Unlike patients with PARDS, adjunctive therapies were used infrequently in non-PARDS AHRF patients. AHRF patients without PARDS had more ventilator-free days than PARDS patients (16.4 ± 9.4 vs. 11.2 ± 10.5; p = 0.002). All-cause PICU mortality in AHRF cases was higher in PARDS vs. non-PARDS patients (30.8% [95% CI, 21.5-41.3] vs. (14.4% [95% CI, 7.9-23.4]; p = 0.01).
Conclusions:
In our 2019-2021 PICU population, the prevalence of AHRF is 2.8% of IMV cases. Of such patients, the prevalence of PARDS was 50.3%, and there was a 30.8% mortality, which was higher than in cases of AHRF without PARDS.
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