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[Pediatric characteristics of adult respiratory distress syndrome: a meta-analysis]
1Klinik und Poliklinik für Kinderheilkunde, Westfälische Wilhelms-Universität Münster.
Insights
Pediatric Acute Respiratory Distress Syndrome (ARDS) is often fatal, with infection, aspiration, and trauma as primary causes. High mortality rates and frequent complications like multiorgan failure necessitate further clinical trials for effective treatments.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Medical Literature Analysis
Background:
- Acute Respiratory Distress Syndrome (ARDS) in children (0-15 years) requires comprehensive understanding for improved therapeutic strategies.
- Existing literature on pediatric ARDS is fragmented, necessitating a consolidated knowledge base.
- Identifying key etiological factors and prognostic indicators is crucial for managing pediatric ARDS.
Purpose of the Study:
- To synthesize current knowledge on pediatric ARDS through a meta-analysis of available literature.
- To inform the planning of controlled studies for novel therapeutic interventions in pediatric ARDS.
- To identify common causes, treatment parameters, complications, and outcomes in childhood ARDS.
Main Methods:
- A meta-analysis was conducted using Medline to identify relevant publications meeting predefined minimal criteria.
- Included data from 4 studies (50 patients) and 48 individual case reports (48 patients).
- Analyzed etiological factors, therapeutic interventions (PEEP, PIP, FiO2), complications, and mortality rates.
Main Results:
- Infection (21-30%), aspiration (12-23%), and trauma (10-23%) were the most common causes of pediatric ARDS.
- High respiratory pressures (PEEP: 14.7-15.8 cm H2O; PIP: 59.6-61.9 cm H2O) and prolonged high FiO2 (>0.5 for 10.1-10.4 days) were frequently used.
- High rates of complications including barotrauma (43.8-78%), infection (60.4%), and multiorgan failure (66.7%) were observed.
- Mortality rates ranged from 31.3% to 52%, indicating a significant fatality rate in childhood ARDS.
Conclusions:
- Pediatric ARDS carries a substantial mortality risk, with nearly half of affected children succumbing.
- Multiorgan failure and the use of high FiO2 and PEEP levels are early indicators of poor prognosis.
- Clinical trials for therapeutic agents, building on successful animal study findings, are warranted and justified for pediatric ARDS.
Abstract:
A meta-analysis of the literature is carried out in order to present the current knowledge of ARDS in childhood (0-15 years). This might be helpful for planning controlled studies on new therapeutic measures (e.g. surfactant replacement, antioxidants, extracorporeal gas exchange). By means of Medline all available publications were taken into account referring to minimal criteria defined before. There were 4 studies (50 patients) and 48 individual case-reports (48 patients). Most often ARDS was caused by infection (21 resp. 30%), aspiration (12 resp. 23%) and trauma (10 resp. 23%). Therapeutically high respiration pressures and toxic oxygen tensions were applied generally (average maximum PEEP: 14.7 resp. 15.8 cm H2O; average maximum PIP: 59.6 resp. 61.9 cm H2O; FiO2 > 0.5 for an average of 10.1 resp. 10.4 days). The most frequent complications were barotrauma (43.8 resp. 78%), infection (60.4%) and multiorgan failure (66.7%). Mortality rate was 31.3 resp. 52%. So also in childhood almost every second case is fatal. Especially multiorgan failure as well as high levels of FiO2 and PEEP indicate bad prognosis at an early stage. Therefore it is necessary and justified to perform clinical trials on therapeutic agents successfully tested in animal studies before.