Whole pulmonary assessment 1 year after paediatric acute respiratory distress syndrome: prospective multicentre study,Annals of Intensive Care

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Whole pulmonary assessment 1 year after paediatric acute respiratory distress syndrome: prospective multicentre study
Annals of Intensive Care ( IF 8.1 ) Pub Date : 2022-08-20 , DOI: 10.1186/s13613-022-01050-4
Véronique Nève _{1,

2,

3} , Ahmed Sadik ₄ , Laurent Petyt ₅ , Stéphane Dauger ₆ , Ahmed Kheniche ₇ , André Denjean ₈ , Pierre-Louis Léger ₉ , François Chalard ₁₀ , Michèle Boulé ₁₁ , Etienne Javouhey ₁₂ , Philippe Reix ₁₃ , Isabelle Canterino ₁₄ , Valérie Deken _{15,

16} , Régis Matran _{1,

2,

3} , Stéphane Leteurtre _{4,

16} , Francis Leclerc _{4,

16}

Affiliation

Pulmonary Function Testing Department, CHU Lille, 2 avenue Oscar Lambret, 59000, Lille, France.
Univ. Lille, ULR 4483, IMPECS, 59000, Lille, France.
Institut Pasteur de Lille, 59000, Lille, France.
Réanimation pédiatrique, CHU Lille, 59000, Lille, France.
Imaging Department, University Hospital, 59000, Lille, France.
Pediatric Intensive Care Unit, Assistance Publique, Hôpitaux de Paris, Robert Debré University Hospital, Université de Paris, Paris, France.
Imaging Department, Assistance Publique, Hôpitaux de Paris, Robert Debré University Hospital, Paris, France.
Pulmonary Function Testing Department, Assistance Publique, Hôpitaux de Paris, Robert Debré University Hospital, Université de Paris, Paris, France.
Pediatric and Neonatal Intensive Care Unit, Assistance Publique, Hôpitaux de Paris, Armand-Trousseau Hospital, Sorbonne University, Paris, France.
Imaging Department, Assistance Publique, Hôpitaux de Paris, Armand-Trousseau Hospital, Sorbonne University, Paris, France.
Pulmonary Function Testing Department, Assistance Publique, Hôpitaux de Paris, Armand- Trousseau University Hospital, Sorbonne University, Paris, France.
Pediatric Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Lyon1, Lyon, France.
Pediatric Pulmonology Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Lyon1, Lyon, France.
Imaging Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Lyon1, Lyon, France.
Service de Biostatistique et Data Management, CHU Lille, 59000, Lille, France.
Évaluation des technologies de santé et des pratiques médicales, Univ. Lille, ULR 2694, METRICS, 59000, Lille, France.

Background

Long-term pulmonary sequelae, including 1-year thoracic computed tomography (CT) sequelae of paediatric acute respiratory distress syndrome (ARDS) remain unknown. The purpose of the study was to determine pulmonary abnormalities in child survivors of pulmonary (p-ARDS) and extra-pulmonary ARDS (ep-ARDS) 1 year after paediatric intensive care unit discharge (PICUD).

Methods

Prospective multicentre study in four paediatric academic centres between 2005 and 2014. Patients with ARDS were assessed 1 year after PICUD with respiratory symptom questionnaire, thoracic CT and pulmonary function tests (PFT).

Results

39 patients (31 p-ARDS) aged 1.1–16.2 years were assessed. Respiratory symptoms at rest or exercise and/or respiratory maintenance treatment were reported in 23 (74%) of children with p-ARDS but in 1 (13%) of those with ep-ARDS. Thoracic CT abnormalities were observed in 18 (60%) of children with p-ARDS and 4 (50%) of those with ep-ARDS. Diffuse and more important CT abnormalities, such as ground glass opacities or mosaic perfusion patterns, were observed in 5 (13%) of children, all with p-ARDS. PFT abnormalities were observed in 30 (86%) of patients: lung hyperinflation and/or obstructive pattern in 12 (34%) children, restrictive abnormalities in 6 (50%), mild decrease in diffusing capacity in 2 (38%) and 6-min walking distance decrease in 11 (73%). Important PFT abnormalities were observed in 7 (20%) children, all with p-ARDS. Increasing driving pressure (max plateau pressure—max positive end-expiratory pressure) was correlated with increasing CT-scan abnormalities and increasing functional residual capacity (more hyperinflation) (p < 0.005).

Conclusions

Children surviving ARDS requiring mechanical ventilation present frequent respiratory symptoms, significant CT-scan and PFT abnormalities 1 year after PICUD. This highlights the need for a systematic pulmonary assessment of these children.

Trial registration The study was registered on Clinical Trials.gov PRS (ID NCT01435889)

中文翻译：

小儿急性呼吸窘迫综合征后 1 年的全肺评估：前瞻性多中心研究

背景

长期肺部后遗症，包括儿童急性呼吸窘迫综合征 (ARDS) 的 1 年胸部计算机断层扫描 (CT) 后遗症仍然未知。该研究的目的是确定儿童重症监护病房 (PICUD) 出院后 1 年的肺部 (p-ARDS) 和肺外 ARDS (ep-ARDS) 儿童幸存者的肺部异常情况。

方法

2005 年至 2014 年间在四个儿科学术中心进行的前瞻性多中心研究。在 PICUD 后 1 年，通过呼吸症状问卷、胸部 CT 和肺功能检查 (PFT) 对 ARDS 患者进行了评估。

结果

评估了 39 名年龄在 1.1-16.2 岁之间的患者（31 名 p-ARDS）。23 名 (74%) 的 p-ARDS 患儿报告了休息或运动和/或呼吸维持治疗时的呼吸系统症状，而 1 名 (13%) 的 ep-ARDS 患儿报告了呼吸系统症状。18 名 (60%) 的 p-ARDS 患儿和 4 名 (50%) 的 ep-ARDS 患儿出现胸部 CT 异常。在 5 名 (13%) 患有 p-ARDS 的儿童中观察到弥漫性和更重要的 CT 异常，例如磨玻璃影或马赛克灌注模式。在 30 (86%) 名患者中观察到 PFT 异常：12 (34%) 名儿童出现肺过度充气和/或阻塞模式，6 (50%) 名儿童出现限制性异常，2 名 (38%) 和 6 名儿童弥散能力轻度下降-min 步行距离减少 11 (73%)。在 7 (20%) 名儿童中观察到重要的 PFT 异常，所有儿童均患有 p-ARDS。p < 0.005)。