BACKGROUND AND AIM: Pediatric Acute Respiratory Distress Syndrome (PARDS) is a frequent cause of hypoxic respiratory failure. A driving pressure greater than 15 cm/ H2O in adults is associated with poor outcomes. The pulmonary mechanics change in children and the threshold associated with poor outcomes is unknown. ObjectiveTo establish the driving pressure level associated with poor outcomes in children PARDS requiring invasive mechanical ventilation in Pediatric Intensive Care Units (PICU). METHOD:We conducted a prospective multicenter cohort in 12 PICU in Colombia. Patients included were between 1 month and 18 years of age with moderate to severe ARDS requiring PICU admission and mechanical ventilation, during February/2017 and November/2019. Median and interquartile range were used for quantitative variables, and absolute and relative values for qualitative variables. Demographic and clinical variables were compared according to mortality outcome with chi square or the Mann Whitney U test. A p<0.05 was considered statistically significant RESULTS:The cohort included 212 subjects, of which 62% were males. The median age was 11 months. Main diagnosis on admission was septic shock, present in 48% of subjects, followed by bacterial pneumonia (34%) and viral pneumonia (32%). Severe oxygenation disorder with a PaO 2 /FiO 2 <100 was present in 54% of subjects on admission. PaO 2 /FiO 2 within 100-199 were seen in 41% and close to 5% debuted with a mild oxygenation disorder CONCLUSIONS: A driving pressure >18 cm/H2O at 48 hours after mechanical ventilation in children with moderate to severe ARDS is associated with increased risk of poor outcomes. This risk progressively increases with greater driving pressures.

Background: Improved survival and intensified treatment protocols in pediatric oncology have resulted in an increased need for intensive care. However, in resource-constrained settings, the higher morbidity and mortality of these patients raises sensitive issues around the optimal use of limited critical care resources.Methods: Single-center, 10-year retrospective review of pediatric oncology patients admitted to the pediatric intensive care unit (PICU).Results: Of the 117 admissions, 70.1% had solid tumors, 61.5% were admitted electively, and 76.1% were admitted for noninfective indications. PICU mortality of oncology patients was 18.8% relative to the PICU mortality of all patients in the same period of 10.5%. In a multivariable analysis, factors shown to be independently associated with PICU mortality were infective indications for admission (relative risk = 3.83, confidence interval: 1.16; 12.6, P = 0.028) and vasoactive support (relative risk = 7.50, confidence interval: 1.72; 32.8, P = 0.0074). Conclusion:The increased mortality associated with sepsis, organ dysfunction and need for organ support underscores the need for earlier recognition of and intervention in pediatric oncology patients requiring intensive care. Further prospective studies are needed to identify the most critical areas for improvement in the referral of these children to PICU, to optimize care and improve outcomes.