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Specific Viral Etiologies Are Associated With Outcomes in Pediatric Acute Respiratory Distress Syndrome*

Roberts, Anna L. BA1; Sammons, Julia S. MD, MSCE2,3; Mourani, Peter M. MD4; Thomas, Neal J. MD, MSc5; Yehya, Nadir MD1

Pediatric Critical Care Medicine: September 2019 - Volume 20 - Issue 9 - p e441-e446
doi: 10.1097/PCC.0000000000002008
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Objectives: Infectious pneumonia is the most common cause of acute respiratory distress syndrome, with viruses frequently implicated as causative. However, the significance of viruses in pediatric acute respiratory distress syndrome is unknown. We aimed to characterize the epidemiology of viral pneumonia in pediatric acute respiratory distress syndrome and compare characteristics and outcomes between pneumonia subjects with and without viruses. Secondarily, we examined the association between specific viruses and outcomes.

Design: We performed a secondary analysis of a prospectively enrolled pediatric acute respiratory distress syndrome cohort. Subjects with pneumonia acute respiratory distress syndrome underwent testing of respiratory secretions for viruses and culture for bacteria and fungi and were stratified according to presence or absence of a virus.

Setting: Tertiary care children’s hospital.

Patients: Children with acute respiratory distress syndrome.

Interventions: None.

Measurements and Main Results: Of 544 children with acute respiratory distress syndrome, 282 (52%) had pneumonia as their inciting etiology, of whom 212 were virus-positive. In 141 of 282 (50%) pneumonia acute respiratory distress syndrome cases, a virus was the sole pathogen identified. Virus-positive pneumonia had fewer organ failures but worse oxygenation, relative to virus-negative pneumonia, with no differences in antibiotic use, ventilator duration, or mortality. Subjects with respiratory syncytial virus-associated acute respiratory distress syndrome had lower mortality (0%), and subjects with influenza-associated acute respiratory distress syndrome had shorter ventilator duration, relative to other viral acute respiratory distress syndrome. Nonadeno herpesviruses, tested for exclusively in immunocompromised subjects, had greater than 80% mortality.

Conclusions: Pneumonia was the most common cause of pediatric acute respiratory distress syndrome, and viruses were commonly isolated as the sole pathogen. Respiratory syncytial virus and influenza were associated with better outcomes relative to other viral etiologies. Viral pneumonias in immunocompromised subjects, particularly nonadeno herpesviruses, drove the mortality rate for pneumonia acute respiratory distress syndrome. Specific viral etiologies are associated with differential outcomes in pediatric acute respiratory distress syndrome and should be accounted for in future studies.

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

2Department of Pediatrics, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA.

3Department of Infection Prevention and Control, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA.

4Section of Critical Care, Department of Pediatrics, Children’s Hospital Colorado and University of Colorado at Denver, Aurora, CO.

5Division of Pediatric Critical Care Medicine, Department of Pediatrics and Public Health Science, Penn State Hershey Children’s Hospital, Hershey, PA.

*See also p. 899.

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/pccmjournal).

Dr. Thomas’s institution received funding from Gene Fluidics, and he received funding from Therabron and CareFusion. Dr. Yehya’s institution received funding from the National Institutes of Health (NIH) (K23-HL136688)/National Heart, Lung, and Blood Institute, and he received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.

This work was performed at Children’s Hospital of Philadelphia.

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

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