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New Morbidity and Discharge Disposition of Pediatric Acute Respiratory Distress Syndrome Survivors*

Keim, Garrett, MD1; Watson, R. Scott, MD, MPH2; Thomas, Neal J., MD, MSc3; Yehya, Nadir, MD1

doi: 10.1097/CCM.0000000000003341
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Objectives: Much of the research related to pediatric acute respiratory distress syndrome has focused on inhospital mortality and interventions affecting this outcome. Limited data exist on survivors’ morbidity, hospital disposition, and 1-year survival. The aim of this study was to determine new morbidity rate, discharge disposition, and 1-year mortality for survivors of pediatric acute respiratory distress syndrome.

Design: Secondary analysis of prospective cohort study.

Setting: Quaternary children’s hospital.

Patients: Three-hundred sixteen mechanically ventilated children with pediatric acute respiratory distress syndrome (Berlin and Pediatric Acute Lung Injury Consensus Conference criteria) between July 2011 and December 2014.

Interventions: None.

Measurements and Main Results: We performed secondary analysis of a prospectively recruited cohort of 316 mechanically ventilated children with pediatric acute respiratory distress syndrome between July 2011, and December 2014. Preillness and hospital discharge Functional Status Scale score were determined via chart review, and factors associated with new morbidity, defined as an increase of Functional Status Scale score of 3 or more, were analyzed. Demographic variables, pediatric acute respiratory distress syndrome characteristics, and ventilator management were tested for association with development of new morbidity, discharge disposition, and 1-year mortality. Inhospital mortality of pediatric acute respiratory distress syndrome was 13.3% (42/316). Of 274 survivors to hospital discharge, new morbidity was seen in 63 patients (23%). Discharge to rehabilitation rate was 24.5% (67/274) and associated with development of new morbidity. One- and 3-year mortality of survivors was 5.5% (15 deaths) and 8% (22 deaths) and was associated with baseline Functional Status Scale, immunocompromised status, Pediatric Risk of Mortality III, and organ failures at pediatric acute respiratory distress syndrome onset, but not with pediatric acute respiratory distress syndrome severity.

Conclusions: New morbidity was common after pediatric acute respiratory distress syndrome and appears to be intermediate phenotype between survival without morbidity and death, making it a useful metric in future interventional and outcome studies in pediatric acute respiratory distress syndrome.

1Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA.

2Department of Pediatrics, University of Washington, Seattle, WA.

3Department of Pediatrics, Penn State University College of Medicine, Hershey, PA.

*See also p. 1866.

Dr. Keim assisted in the conceptualization of the study, preformed the majority of the data collection, and drafted the initial article. Dr. Watson and Thomas contributed their expertise in long-term outcome studies, reviewed the data, and assisted in the revision of the article. Dr. Yehya originally conceptualized the study, assisted in data collection, preformed the initial data analysis, and contributed to the initial article review and revision of the final article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by grants from the National Institutes of Health K12-HL109009 and K23-HL136688 (to Dr. Yehya).

Dr. Keim received support for article research from the National Institutes of Health (NIH). Dr. Thomas reports personal fees from Therabron and CareFusion and grants from the Federal Drug Association, all outside of the submitted work. Dr. Thomas’ institution received funding from GeneFluidics, and he received funding from CareFusion and Therabron. Dr. Yehya’s institution received funding from the NIH/National Heart, Lung, and Blood Institute, and he received support for article research from the NIH. Dr. Watson has disclosed that he does not have any potential conflicts of interest.

For information regarding this article, E-mail: keimg@email.chop.edu

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