Epidemiology and Outcomes of Critically Ill Children at Risk for Pediatric Acute Respiratory Distress Syndrome: A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study*,Critical Care Medicine

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Epidemiology and Outcomes of Critically Ill Children at Risk for Pediatric Acute Respiratory Distress Syndrome: A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study*
Critical Care Medicine ( IF 8.8 ) Pub Date : 2022-03-01 , DOI: 10.1097/ccm.0000000000005287
Steven L Shein ₁ , Aline B Maddux ₂ , Margaret J Klein ₃ , Anoopindar Bhalla _{3,

4} , George Briassoulis ₅ , Mary K Dahmer ₆ , Guillaume Emeriaud ₇ , Heidi R Flori ₆ , Rainer Gedeit ₈ , Stavroula Ilia ₅ , Martin C J Kneyber _{9,

10} , Natalie Napolitano ₁₁ , Shinichiro Ohshimo ₁₂ , Marti Pons-Òdena _{13,

14} , Sarah Rubin ₁₅ , Benjamin R White ₁₆ , Nadir Yehya ₁₇ , Robinder Khemani _{3,

4} , Lincoln Smith ₁₈ ,

Affiliation

Division of Pediatric Critical Care Medicine, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH.
Pediatric Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.
Department of Anesthesiology and Critical Care Medicine, The University of Southern California, Los Angeles, CA.
Pediatric Intensive Care Unit, Medical School, University of Crete, Heraklion, Greece.
Division of Pediatric Critical Care, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
Department of Pediatrics, Université de Montréal, Montreal, QC, Canada.
Department of Pediatrics, Medical College of Wisconsin, Critical Care Section, Children's Wisconsin, Milwaukee, WI.
Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands.
Critical Care, Anaesthesiology, Peri-Operative Medicine & Emergency Medicine, The University of Groningen, Groningen, The Netherlands.
Respiratory Care Department, Children's Hospital of Philadelphia, Philadelphia, PA.
Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Pediatric Intensive Care and Intermediate Care Department, Sant Joan de Déu University Hospital, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, Spain.
Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA.
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA.
Division of Pediatric Critical Care, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA.

OBJECTIVES:

Interventional trials aimed at pediatric acute respiratory distress syndrome prevention require accurate identification of high-risk patients. In this study, we aimed to characterize the frequency and outcomes of children meeting “at risk for pediatric acute respiratory distress syndrome” criteria as defined by the Pediatric Acute Lung Injury Consensus Conference.

DESIGN:

Planned substudy of the prospective multicenter, international Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study conducted during 10 nonconsecutive weeks (May 2016–June 2017).

SETTING:

Thirty-seven international PICUs.

PATIENTS:

Three-hundred ten critically ill children meeting Pediatric Acute Lung Injury Consensus Conference “at-risk for pediatric acute respiratory distress syndrome” criteria.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We evaluated the frequency of children at risk for pediatric acute respiratory distress syndrome and rate of subsequent pediatric acute respiratory distress syndrome diagnosis and used multivariable logistic regression to identify factors associated with subsequent pediatric acute respiratory distress syndrome. Frequency of at risk for pediatric acute respiratory distress syndrome was 3.8% (95% CI, 3.4–5.2%) among the 8,122 critically ill children who were screened and 5.8% (95% CI, 5.2–6.4%) among the 5,334 screened children on positive pressure ventilation or high-flow oxygen. Among the 310 at-risk children, median age was 2.1 years (interquartile range, 0.5–7.3 yr). Sixty-six children (21.3%) were subsequently diagnosed with pediatric acute respiratory distress syndrome, a median of 22.6 hours (interquartile range, 9.8–41.0 hr) later. Subsequent pediatric acute respiratory distress syndrome was associated with increased mortality (21.2% vs 3.3%; p < 0.001) and longer durations of invasive ventilation and PICU care. Subsequent pediatric acute respiratory distress syndrome rate did not differ by respiratory support modality at the time of meeting at risk criteria but was independently associated with lower initial saturation:Fio₂ ratio, progressive tachycardia, and early diuretic administration.

CONCLUSIONS:

The Pediatric Acute Lung Injury Consensus Conference “at-risk for pediatric acute respiratory distress syndrome” criteria identify critically ill children at high risk of pediatric acute respiratory distress syndrome and poor outcomes. Interventional trials aimed at pediatric acute respiratory distress syndrome prevention should target patients early in their illness course and include patients on high-flow oxygen and positive pressure ventilation.

中文翻译：

有儿科急性呼吸窘迫综合征风险的危重儿童的流行病学和结果：一项儿科急性呼吸窘迫综合征发病率和流行病学研究*

目标：

旨在预防儿科急性呼吸窘迫综合征的干预试验需要准确识别高危患者。在这项研究中，我们旨在描述符合小儿急性肺损伤共识会议定义的“小儿急性呼吸窘迫综合征风险”标准的儿童的频率和结果。

设计：

计划在 10 个非连续周（2016 年 5 月至 2017 年 6 月）期间进行的前瞻性多中心国际儿科急性呼吸窘迫综合征发病率和流行病学研究的子研究。

环境：

37 个国际 PICU。

患者：

三百十名重症儿童符合小儿急性肺损伤共识会议“小儿急性呼吸窘迫综合征风险”标准。

干预措施：

没有任何。

测量和主要结果：

我们评估了患小儿急性呼吸窘迫综合征风险的儿童的频率和随后的小儿急性呼吸窘迫综合征诊断率，并使用多变量逻辑回归来确定与随后的小儿急性呼吸窘迫综合征相关的因素。在接受筛查的 8,122 名重症儿童中，患小儿急性呼吸窘迫综合征风险的频率为 3.8%（95% CI，3.4-5.2%），在接受筛查的 5,334 名儿童中，这一比例为 5.8%（95% CI，5.2-6.4%）正压通气或高流量氧气。在 310 名高危儿童中，中位年龄为 2.1 岁（四分位间距，0.5-7.3 岁）。66 名儿童 (21.3%) 随后被诊断出患有小儿急性呼吸窘迫综合征，中位时间为 22.6 小时（四分位间距，9.8-41.0 小时）。p < 0.001) 和有创通气和 PICU 护理的持续时间更长。_{随后的儿科急性呼吸窘迫综合征发生率在满足风险标准}时因呼吸支持方式而异，但与较低的初始饱和度：Fio2 比率、进行性心动过速和早期利尿剂给药独立相关。