TY - JOUR
T1 - Epidemiology and Outcomes of Critically Ill Children at Risk for Pediatric Acute Respiratory Distress Syndrome
T2 - A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study∗
AU - Shein, Steven L.
AU - Maddux, Aline B.
AU - Klein, Margaret J.
AU - Bhalla, Anoopindar
AU - Briassoulis, George
AU - Dahmer, Mary K.
AU - Emeriaud, Guillaume
AU - Flori, Heidi R.
AU - Gedeit, Rainer
AU - Ilia, Stavroula
AU - Kneyber, Martin C.J.
AU - Napolitano, Natalie
AU - Ohshimo, Shinichiro
AU - Pons-Òdena, Marti
AU - Rubin, Sarah
AU - White, Benjamin R.
AU - Yehya, Nadir
AU - Khemani, Robinder
AU - Smith, Lincoln
N1 - Funding Information:
Supported, in part, by Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology funding from University of Southern California Clinical Translational Science Institute; Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada; Réseau en Santé Respiratoire du Fonds de Recherche Quebec-Santé; and Children’s Hospital Los Angeles, Department of Anesthesiology and Critical Care Medicine.
Funding Information:
Dr. Shein received funding from Hill Ward Henderson. Dr. Maddux’s institution received funding from the National Institute of Child Health and Human Development (NICHD) (K23HD096018). Dr. Bhalla’s institution received funding from the Southern California Clinical and Translational Science Institute. Drs. Bhalla, Flori, Yehya, and Khemani received support for article research from the National Institutes of Health (NIH). Dr. Dahmer’s institution received funding from the NICHD. Drs. Dahmer and Kneyber’s institutions received funding from the National Heart, Lung, and Blood Institute. Dr. Emeriaud’s institution received funding from Fonds de recherche du Québec Santé and Maquet. Drs. Flori’s and Yehya’s institutions received funding from the NIH. Dr. Flori disclosed that she is on the Executive Board of the Michigan Thoracic Society and the Executive Board of the Pediatric Acute Lung Injury and Sepsis Investigators Network. Dr. Kneyber’s institution received funding from ZorgOnderzoek Nederland, Medische wetenschappen; he received funding from Vyaire, Stitching Beatrix Kinderziekenhuis, University Medical Center Groningen Technical, and Applied Biosignals. Dr. Napolitano’s institution received funding from Drager, Vero-Biotech, and Smiths Medical; she received funding from Philips and Actuated Medical. Dr. Yehya’s institution received funding from Pfizer. Dr. Khemani’s institution received funding from the National Center for Advancing Translational Science (UL1TR001855 and UL1TR000130). The remaining authors have disclosed that they do not have any potential conflicts of interest.
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - 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:Fio2ratio, 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.
AB - 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:Fio2ratio, 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.
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U2 - 10.1097/CCM.0000000000005287
DO - 10.1097/CCM.0000000000005287
M3 - Article
C2 - 34582416
AN - SCOPUS:85125014374
SN - 0090-3493
VL - 50
SP - 363
EP - 374
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 3
ER -