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Clinical Profile and Predictors of Outcome of Pediatric Acute Respiratory Distress Syndrome in a PICU: A Prospective Observational Study*

Yadav, Bharti MD; Bansal, Arun MD, FCCM, FRCPCH; Jayashree, Muralidharan MD, FIAP

Pediatric Critical Care Medicine: June 2019 - Volume 20 - Issue 6 - p e263-e273
doi: 10.1097/PCC.0000000000001924
Online Clinical Investigations
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Objectives: To study the clinical profile, predictors of mortality, and outcomes of pediatric acute respiratory distress syndrome.

Design: A prospective observational study.

Setting: PICU, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Patients: All children (age > 1 mo to < 14 yr) admitted in PICU with a diagnosis of pediatric acute respiratory distress syndrome (as per Pediatric Acute Lung Injury Consensus Conference definition) from August 1, 2015, to November 2016.

Interventions: None.

Measurements and Main Results: Out of 1,215 children admitted to PICU, 124 (11.4%) had pediatric acute respiratory distress syndrome. Fifty-six children (45.2%) died. Median age was 2.75 years (1.0–6.0 yr) and 66.9% were male. Most common primary etiologies were pneumonia, severe sepsis, and scrub typhus. Ninety-seven children (78.2%) were invasively ventilated. On multiple logistic regressions, Lung Injury Score (p = 0.004), pneumothorax (p = 0.012), acute kidney injury at enrollment (p = 0.033), Fio2-D1 (p = 0.018), and Pao2/Fio2 ratio-D7 (p = 0.020) were independent predictors of mortality. Positive fluid balance (a cut-off value > 102.5 mL/kg; p = 0.016) was associated with higher mortality at 48 hours. Noninvasive oxygenation variables like oxygenation saturation index and saturation-Fio2 ratio were comparable to previously used invasive variables (oxygenation index and Pao2/Fio2 ratio) in monitoring the course of pediatric acute respiratory distress syndrome.

Conclusions: Pediatric acute respiratory distress syndrome contributes to a significant burden in the PICU of a developing country and is associated with significantly higher mortality. Infection remains the most common etiology. Higher severity of illness scores at admission, development of pneumothorax, and a positive fluid balance at 48 hours predicted poor outcome.

All authors: Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

*See also p. 584.

This work was performed at the Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

The authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Arun Bansal, MD, FCCM, FRCPCH, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India 160012. E-mail: drarunbansal@gmail.com

Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies