A single‐center PICU present status survey of pediatric sepsis‐related acute respiratory distress syndrome

Abstract

Background: To describe the incidence, clinical features, outcomes, and mortality risk factors of sepsis associated with acute respiratory distress syndrome (ARDS) in pediatric patients. Methods: Patients were included in the study if they met the 2005 version of the International Pediatric Sepsis Consensus Conference and met the Pediatric Acute Lung Injury Consensus Conference (PALICC) definition within 48 h of sepsis diagnosis. Patients were classified as mild, moderate, and severe by the worst oxygenation index (OI) within 72 h of sepsis-related ARDS diagnosis. Results: Between January 1, 2015 and March 13, 2020, 9836 patients were admitted to the pediatric intensive care unit (PICU) of the Children's Hospital of Chongqing Medical University and 828 (8.4%) were identified with sepsis and 203 (24.5%) met the PALICC definition with a PICU mortality rate of 24.6% (50/203) and a 90-day mortality rate of 40.9% (83/203). After adjusting for septic shock, the pediatric logistic organ dysfunction 2 (PELOD-2), high-frequency oscillation ventilation (HFOV), and continuous renal replacement therapy (CRRT), the variables that retained an independent association with increased 90-day mortality in pediatric sepsis-related ARDS included ARDS severity, the pediatric risk of mortality III (PRISM III), number of organ dysfunctions and use of vasoactive drug types during PICU stay. Conclusions: PICU mortality in pediatric sepsis-related ARDS was high (24.6%) and severity of hypoxemia based on the worst OI value 72 h after meeting the PALICC definition accurately stratified the patient outcomes. ARDS severity, PRISM III score, comorbid multiorgan dysfunction, and use of multiple vasoactive drugs during PICU stay were independent risk factors for 90-day mortality in pediatric sepsis-related ARDS.

Sepsis-related pediatric acute respiratory distress syndrome

“…The incidence of sepsis-related PARDS was 19.7%, which was comparable to other studies that reported rates ranging from 8.2% to 22%, [ 5 19 20 ]and PICU mortality rate was 30.7% (8/26) which was higher than a recent retrospective study that revealed the PICU mortality rate of sepsis-related PARDS was 24.6%. [ 21 ]A single-center retrospective study involving 203 sepsis-related PARDS from 828 sepsis patients showed that ARDS severity, PRISM III, and the number of organ dysfunction were associated with increased 90-day mortality in sepsis-related PARDS. [ 21 ]They recruited 20 patients with noninvasively ventilated PARDS, whereas our study recruited only patients with invasively ventilated PARDS.…”

“…[ 21 ]A single-center retrospective study involving 203 sepsis-related PARDS from 828 sepsis patients showed that ARDS severity, PRISM III, and the number of organ dysfunction were associated with increased 90-day mortality in sepsis-related PARDS. [ 21 ]They recruited 20 patients with noninvasively ventilated PARDS, whereas our study recruited only patients with invasively ventilated PARDS. Our study found that hemato-oncologic patients, low platelet count, high severity score (PRISM III and PELOD), high serum lactate, and high procalcitonin were the risk factors for sepsis-related PARDS.…”