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Timing of recovery of lung function after severe hypoxemic respiratory failure in children
N D Golder1, R Lane, R C Tasker
1Department of Paediatric Intensive Care, Great Ormond Street Hospital for Children, London, UK.
Insights
Children with severe acute hypoxemic respiratory failure (AHRF) may experience lung function recovery for up to 12 months. A one-year follow-up is recommended for assessing outcomes and providing counseling for pediatric AHRF patients.
Area of Science:
- Pediatric critical care medicine
- Pulmonology
- Respiratory physiology
Background:
- Severe acute hypoxemic respiratory failure (AHRF) in children can lead to prolonged respiratory compromise.
- Understanding the timeline of lung function recovery is crucial for managing pediatric patients post-critical illness.
Purpose of the Study:
- To characterize the timing and extent of lung function recovery in children following severe AHRF.
- To establish a potential timeframe for assessing long-term outcomes in pediatric AHRF survivors.
Main Methods:
- Serial observational follow-up study.
- Involved clinical and lung function measurements in five critically ill children (aged 5-14 years) over 53 months.
- Utilized spirometry, including forced vital capacity (FVC) and forced vital capacity in the first second (FEV1).
Main Results:
- Clinical recovery required 3-5 months of convalescence, with symptoms like lethargy and dyspnea.
- Wheezing developed in all patients between 3-12 months post-illness, with four requiring long-term bronchodilators.
- Lung function (FVC, FEV1) improved significantly by 6-12 months, plateauing thereafter, indicating a restrictive defect.
Conclusions:
- Pulmonary recovery in children after severe AHRF typically occurs within 6-12 months.
- A 1-year follow-up assessment provides a rational basis for evaluating outcomes and guiding long-term care and parental counseling for pediatric AHRF survivors.
Objective:
To describe the timing of recovery of lung function after severe acute hypoxemic respiratory failure (AHRF) in children.
Design:
A serial observational follow-up study of clinical and lung function measurements up to 53 months after acute illness.
Setting:
University pediatric intensive care unit in a national children's hospital.
Patients:
Five critically ill children aged 5-14 years.
Interventions:
None
Results:
Clinical recovery: each patient required a 3-5 month convalescence before being able to attend full-time school because of lethargy and dyspnea. All patients developed wheeze 3-12 months after illness and four received long-term bronchodilator therapy. Lung function recovery: for both the forced vital capacity (FVC) and forced vital capacity in the first second (FEV1) four patients had abnormally low values, regaining only 60-70% of predicted values for their height and sex, and all of this improvement had occurred by 6-12 months after illness. Beyond this interval, patients remained on their same FVC and FEV1 centile. FEV1/FVC ratios were consistently within the normal range, indicating a predominantly restrictive defect. Changes in peak expiratory flow exhibited a time course of improvement similar to the other lung function tests.
Conclusion:
In children, pulmonary recovery after severe AHRF may occur for 6-12 months. A 1-year follow-up could offer a rational single point for assessment of outcome and long-term counselling of child and parents.