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Outcome of respiratory failure: a case-control study
R Caballero1, R H Clark, J A Wright
1Division of Critical Care, Cook Children's Medical Center, Fort Worth, Texas, USA.
Insights
Predicting mortality in pediatric respiratory failure remains challenging. An alveolar-arterial oxygen gradient (AaDO2) over 400 torr weakly predicted death, while below 400 torr predicted survival in children needing mechanical ventilation.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Extracorporeal Membrane Oxygenation
Background:
- Extracorporeal membrane oxygenation (ECMO) has been available for pediatric respiratory failure for nearly a decade.
- Clear institutional criteria for initiating ECMO in pediatric respiratory failure are lacking.
- Early identification of mortality predictors is crucial for guiding treatment decisions.
Purpose of the Study:
- To evaluate potential predictors of death in pediatric patients with respiratory failure.
- To identify factors that could aid in the early prediction of mortality.
- To inform the development of clearer ECMO initiation criteria.
Main Methods:
- Retrospective chart review of pediatric patients mechanically ventilated for over 48 hours.
- Comparison of nonsurvivors with survivors to identify predictive variables.
- Multivariate analysis applied to potential predictors of mortality.
Main Results:
- Twenty-three pediatric patients died from respiratory failure during the study period.
- An alveolar-arterial oxygen gradient (AaDO2) greater than 400 torr was a weak predictor of death.
- An AaDO2 less than 400 torr was a stronger predictor of survivability.
- Combining variables did not improve predictive accuracy over single variables.
Conclusions:
- Early prediction of mortality from pediatric respiratory failure using the studied variables was not achieved.
- The alveolar-arterial oxygen gradient (AaDO2) shows some predictive value, but not sufficient for definitive early prognostication.
- Further research is needed to establish robust criteria for ECMO initiation in pediatric respiratory failure.
Abstract:
Despite the availability of ECMO (extracorporeal membrane oxygenation) services for nearly a decade, the criteria for the institution of ECMO for pediatric respiratory failure are still not clearly defined. Therefore, a chart review was performed on children who were mechanically ventilated more than 48 hours in 1989-1990 in order to evaluate possible predictors of death from pediatric respiratory failure. Twenty-three children died as a consequence of respiratory failure. Nonsurvivors in both years were compared with the 78 survivors in 1990, and potential predictors were subjected to multivariate analysis. After 4 days of mechanical ventilation, an alveolar-arterial oxygen gradient (AaDO2) greater than 400 torr (53.3 kPa) was a weak predictor of death due to respiratory failure, and yet an AaDO2 less than 400 torr (53.3 kPa) was a stronger predictor of survivability. Combination of variables did not yield a better predictor than any single variable. Early prediction of mortality from respiratory failure in this population was not found.