Incidence and Mortality of Acute Respiratory Distress Syndrome in Children

Schouten, Laura R. A.; Veltkamp, Floor; Bos, Albert P.; Woensel, Job B. M. van; Neto, Ary Serpa; Schultz, Marcus J.; Asperen, Roelie M. Wösten–van

doi:10.1097/ccm.0000000000001388

Cited by 110 publications

(120 citation statements)

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“…Moreover, data from two large population based study in northern European countries, analyzing patients with higher severity of ARDS (moderate and severe ARDS), reports a 90-day long term mortality among 38-41.2% (79,86), and when overall ARDS is analyzed, Linko et al described a 90-day mortality of 47% (82). While in adult population ARDS has shown a clear trend of decrease in mortality over the last decades, these results are not univocally confirmed in pediatric population, as reported with conflicting results in two recent meta-analysis of the literature (103,104). Over the last few years, different RCTs have proposed promising results in terms of ARDS mortality improvement (53,105,106).…”

Section: Ards Mortality-still a Critical Challengecontrasting

confidence: 48%

Definition and epidemiology of acute respiratory distress syndrome

Rezoagli¹,

Fumagalli²,

Bellani³

2017

Ann. Transl. Med.

178

127

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Fifty years ago, Ashbaugh and colleagues defined for the first time the acute respiratory distress syndrome (ARDS), one among the most challenging clinical condition of the critical care medicine. The scientific community worked over the years to generate a unified definition of ARDS, which saw its revisited version in the Berlin definition, in 2014. Epidemiologic information about ARDS is limited in the era of the new Berlin definition, and wide differences are reported among countries all over the world. Despite decades of study in the field of lung injury, ARDS is still so far under-recognized, with 2 out of 5 cases missed by clinicians. Furthermore, although advances of ventilator strategies in the management of ARDS associated with outcome improvements-such as protective mechanical ventilation, lower driving pressure, higher PEEP levels and prone positioning-ARDS appears to be undertreated and mortality remains elevated up to 40%. In this review, we cover the history that led to the current worldwide accepted Berlin definition of ARDS and we summarize the recent data regarding ARDS epidemiology.

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Section: Ards Mortality-still a Critical Challengecontrasting

confidence: 48%

Definition and epidemiology of acute respiratory distress syndrome

Rezoagli¹,

Fumagalli²,

Bellani³

2017

Ann. Transl. Med.

178

127

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“…There are no reliable statistics on the actual incidence or prevalence of influenza-related ARDS in either pediatric or adult populations. However, it is known that the vast majority of ARDS is caused by bacterial sepsis and non-infectious etiologies such as trauma, pancreatitis, smoke inhalation, and drug toxicity [39,40]. Observational studies suggest that within the small proportion of viral-induced ARDS in the pediatric population, most are caused by respiratory syncytial virus and Influenza A, while Influenza A is the predominant viral etiology of ARDS in the adult population [41,42].…”

Section: Influenza Clinical Progression To Pneumonia and Ardsmentioning

confidence: 99%

Influenza virus-related critical illness: pathophysiology and epidemiology

2019

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Influenza virus affects the respiratory tract by direct viral infection or by damage from the immune system response. In humans, the respiratory epithelium is the only site where the hemagglutinin (HA) molecule is effectively cleaved, generating infectious virus particles. Virus transmission occurs through a susceptible individual’s contact with aerosols or respiratory fomites from an infected individual. The inability of the lung to perform its primary function of gas exchange can result from multiple mechanisms, including obstruction of the airways, loss of alveolar structure, loss of lung epithelial integrity from direct epithelial cell killing, and degradation of the critical extracellular matrix. Approximately 30–40% of hospitalized patients with laboratory-confirmed influenza are diagnosed with acute pneumonia. These patients who develop pneumonia are more likely to be < 5 years old, > 65 years old, Caucasian, and nursing home residents; have chronic lung or heart disease and history of smoking, and are immunocompromised. Influenza can primarily cause severe pneumonia, but it can also present in conjunction with or be followed by a secondary bacterial infection, most commonly by Staphylococcus aureus and Streptococcus pneumoniae . Influenza is associated with a high predisposition to bacterial sepsis and ARDS. Viral infections presenting concurrently with bacterial pneumonia are now known to occur with a frequency of 30–50% in both adult and pediatric populations. The H3N2 subtype has been associated with unprecedented high levels of intensive care unit (ICU) admission. Influenza A is the predominant viral etiology of acute respiratory distress syndrome (ARDS) in adults. Risk factors independently associated with ARDS are age between 36 and 55 years old, pregnancy, and obesity, while protective factors are female sex, influenza vaccination, and infections with Influenza A (H3N2) or Influenza B viruses. In the ICU, particularly during the winter season, influenza should be suspected not only in patients with typical symptoms and epidemiology, but also in patients with severe pneumonia, ARDS, sepsis with or without bacterial co-infection, as well as in patients with encephalitis, myocarditis, and rhabdomyolysis.

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“…Defined for adults (1, 2), acute respiratory distress syndrome (ARDS) affects 45,000 children in the United States annually (3), with mortality approaching 30% (4). Absent targeted therapies, lung-protective ventilation (5) remains the mainstay of treatment.…”

Section: Introductionmentioning

confidence: 99%

Disassociating Lung Mechanics and Oxygenation in Pediatric Acute Respiratory Distress Syndrome*

Yehya

Thomas

2017

Critical Care Medicine

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Objective Both oxygenation and peak inspiratory pressure (PIP) are associated with mortality in pediatric ARDS. Since oxygenation and respiratory mechanics are linked, it is difficult to identify which variables, pressure or oxygenation, are independently associated with outcome. We aimed to determine whether respiratory mechanics (PIP, positive end-expiratory pressure [PEEP], ΔP [PIP minus PEEP], tidal volume, dynamic compliance [Cdyn]) or oxygenation (PaO2/FIO2) was associated with mortality. Design Prospective, observational, cohort study. Setting University affiliated pediatric intensive care unit. Patients Mechanically ventilated children with ARDS (Berlin). Interventions None. Measurements and Main Results PIP, PEEP, ΔP, tidal volume, Cdyn, and PaO2/FIO2 were collected at ARDS onset and at 24 hours in 352 children between 2011 and 2016. At ARDS onset, neither mechanical variables nor PaO2/FIO2 were associated with mortality. At 24 hours, PIP, PEEP, ΔP were higher, and Cdyn and PaO2/FIO2 lower, in non-survivors. In multivariable logistic regression, PaO2/FIO2 at 24 hours and ΔPaO2/FIO2 (change in PaO2/FIO2 over the first 24 hours) were associated with mortality, whereas pressure variables were not. Both oxygenation and pressure variables were associated with duration of ventilation in multivariable competing risk regression. Conclusions Improvements in oxygenation, but not in respiratory mechanics, were associated with lower mortality in pediatric ARDS. Future trials of mechanical ventilation in children should focus on oxygenation (higher PaO2/FIO2) rather than lower PIP or ΔP, as oxygenation was more consistently associated with outcome.

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Incidence and Mortality of Acute Respiratory Distress Syndrome in Children

Cited by 110 publications

References 0 publications

Definition and epidemiology of acute respiratory distress syndrome

Definition and epidemiology of acute respiratory distress syndrome

Influenza virus-related critical illness: pathophysiology and epidemiology

Disassociating Lung Mechanics and Oxygenation in Pediatric Acute Respiratory Distress Syndrome*

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