High burden of acquired morbidity in survivors of pediatric acute respiratory distress syndrome

Abstract

Introduction: With improving mortality rates in pediatric acute respiratory distress syndrome (PARDS), functional outcomes in survivors are increasingly important. We aim to describe the change in functional status score (FSS) from baseline to discharge and to identify risk factors associated with poor functional outcomes.Methods: We examined clinical records of patients with PARDS admitted to our pediatric intensive care unit (PICU) from 2009 to 2016. Our primary outcome was acquired morbidity at PICU and hospital discharge (defined by an increase in FSS ≥3 points above baseline). We included severity of illness scores and severity of PARDS in our bivariate analysis for risk factors for acquired morbidity.Results: There were 181 patients with PARDS, of which 90 (49.7%) survived.Median pediatric index of mortality 2 score was 4.05 (1.22, 8.70) and 21 (23.3%) survivors had severe PARDS. A total of 59 (65.6%) and 14 (15.6%) patients had acquired morbidity at PICU and hospital discharge, respectively. Median baseline FSS was 6.00 (6.00, 6.25), which increased to 11.00 (8.75, 12.00) at PICU discharge before decreasing to 7.50 (6.00, 9.25) at hospital discharge. All patients had significantly higher FSS at both PICU and hospital discharge median compared to baseline. Feeding and respiratory were the most affected domains. After adjusting for severity of illness, severity categories of PARDS were not a risk factor for acquired morbidity.Conclusion: Acquired morbidity in respiratory and feeding domains was common in PARDS survivors. Specific attention should be given to these two domains of functional outcomes in these children.

Outcomes of Children Surviving Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

“…Recent studies demonstrated impairments in HRQL (20, 23–25), functional status (23–30), neurocognitive status (31, 32), emotional health (24), and school participation (18, 33) in the months and years after hospitalization with PARDS, as well as high rates of ongoing care needs after hospital discharge (28, 29, 34), postdischarge health resource use (14, 17, 19), late mortality (14, 18, 23, 31, 35, 36), and work absences for parents (33) ( Table 2 ) (Supplemental Table 9, http://links.lww.com/PCC/C297).…”

“…In a study of pediatric trauma patients with PARDS, 77.1% of were discharged with an abnormal Functional Independence Measure (37) score compared with 30.7% of trauma patients without PARDS (29), and 9.4% of these trauma patients with acute respiratory failure had a decline in POPC at discharge (26). In two cohorts of general PICU patients with PARDS, 16–23% experienced new morbidity at hospital discharge based on increase in Functional Status Scale (FSS) (38) score by greater than or equal to 3 points (28, 30) with 39% experiencing any FSS increase, primarily manifested by 28% requiring new feeding support and 11% requiring new respiratory support (30). Following discharge, 31% of PARDS patients had a new morbidity defined by FSS increase greater than or equal to 3 points at 3 months post admission relative to preillness baseline, and 23% had new morbidity at 9 months (23).…”

“…Literature characterizing outcomes of survivors of PARDS has grown substantially since PALICC 2015 (4). We now have information about recovery after PICU admission for PARDS in single-center, multicenter, and population-based studies (14, 17–20, 23–36, 39). Unfortunately, it is increasingly clear that morbidity after hospital discharge from PARDS is common and affects all domains of function, HRQL, and patients’ families.…”

Admission Functional Status is Associated With Intensivists Perception of Extracorporeal Membrane Oxygenation Candidacy for Pediatric Acute Respiratory Failure

“…Although there is variability in mortality rates and availability of ECMO for pediatric ARDS across the world, there is increasing focus on longer-term functional outcomes in both pediatric ARDS (10)(11)(12) and pediatric ECMO survivors (13)(14)(15). This is an important consideration in the context of factors that determine ECMO candidacy.…”

Functional status of pediatric patients after extracorporeal membrane oxygenation: A five-year single-center study

“…The change in the FSS scores from admission to discharge (ΔFSS) in patients with ARDS was 12 (-9, 17), indicating the presence of functional deterioration during the ICU stay. A previous study found that the median baseline FSS score in patients with pediatric ARDS (PARDS) treated with ECMO increased to 11 ( 8 , 12 ) at PICU discharge ( 17 ). Cashen et al reported that 29% of patients with PARDS treated with ECMO had moderate (FSS score of 10–15) and severe abnormal functional status (FSS score of 16–21) at hospital discharge ( 18 ).…”