Incidence, etiology, sociodemographic and clinical characterization of acute respiratory failure in pediatric patients at a high-altitude city: A multicenter cohort study

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Background and Aims Acute respiratory failure (ARF) is a common cause of morbimortality, and a frequent reason for admission to the pediatric intensive care unit (PICU). It requires a high‐flow oxygen device as treatment. Our aim is to determine the frequency and main indications for the use of high‐flow nasal cannula (HFNC), and the prevalence of HFNC failure and its main causes, in three hospitals Methods It is a multicenter prospective cohort study, developed in three hospitals in Bogota. Eligible patients were children older than 1 month and younger than 18 years who presented ARF and required management with an HFNC. The study was carried out between April 2020 and December 2021. The follow‐up was carried out at 1, 6, and 48 h after starting the management. Results Of 685 patients included in the study, 296 developed ARF. The prevalence of patients with ARF who required management with HFNC was 48%. The frequency of the pathologies that cause the ARF was: Bronchiolitis was the most frequent pathology (34.5%), followed by asthmatic crisis (15.5%) and pneumonia (12.7%). The average time of use of HFNC was 81.6 h. Regarding treatment failure with HFNC, 15 patients presented torpid evolution and required invasive mechanical ventilation, with a prevalence of therapeutic failure of the HFNC of 10.6%. Conclusion The use of HFNC is more frequent in patients with bronchiolitis, in children under 2 years of age and in males, which is in line with what has been reported in the literature. In addition, the failure rate of HFNC is low (10.6%), and it may be useful in other pathologies besides bronchiolitis, such as asthma, pneumonia, among others. It opens the possibility to continue evaluating the role of HFNC in pediatric pathology in new studies.

“…Out of the 685 patients with respiratory distress, 66 patients had confirmed SARS‐CoV‐2 infection. 12 , 13 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Use of high‐flow cannula in pediatric patients with respiratory failure: A prospective cohort study in three high‐altitude hospitals

Ante‐Ardila

Garnica

Umaña

et al. 2023

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“…Before analyzing each of the aspects that make up DALYs, the demographic characteristics that could influence the outcomes of the disease were taken, such as age, sex, socioeconomic status, and the main causes that led to development of respiratory failure and causes of mortality. 22 Additionally, for deaths, comorbidities, prenatal history, and immunization status of patients were recorded. YLL represents death that occurs before reaching maximum life expectancy and measures the length of time lost due to premature mortality.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, the pathologies that most contribute to the loss of potential years of life were shock secondary to various pathologies (septic, hypovolemic, and cardiac shock) and ARF itself, ARI (bronchiolitis, pneumonia, and croup) being the main cause that led to respiratory failure. 22 It should be considered that 63% of the patients had some comorbidity, and this could influence the life expectancy of these patients. However, this analysis is not part of the objectives of our study.…”

Section: Discussionmentioning

confidence: 99%

Burden of respiratory failure in pediatric patients: Analysis of a prospective multicenter cohort in Bogotá, Colombia

Hernández‐Corredor,

Plazas‐Pachón,

Argote‐Bolaños

et al. 2023

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Background and AimsThe approach to the burden of disease is a demographic, economic, and a health problem, which requires the design and application of specific measures of cost of the disease, such as disability‐adjusted life years (DALYs), to establish better public health policies in the pediatric population. The aim of this study is to approach the burden of disease in children with acute respiratory failure (ARF) through the calculation of DALYs.MethodsThis study was conducted in the framework of a prospective, multicenter cohort in Bogotá, Colombia. Inclusion criteria were all pediatric patients admitted to the emergency department, hospitalization, and intensive care unit with respiratory distress; eligible patients were all those who developed ARF between April 2020 and December 2021. They were followed‐up during hospitalization, at 30 and 60 days after admission. The Infant/Toddler Quality of Life Questionnaire and KIDSCREEN quality of life scales were applied for follow‐up according to the age group. The results were used to calculate DALYsResultsSix hundred and eighty‐five eligible patients, 296 (43.08%) developed ARF, of these 22 (6.08%) patients died (mortality rate = 7.43%). The total DALYs was 277.164 years. For younger than 9 years, the DALYs were 302.64 years, while for older than 10 years were 40.49 years.ConclusionARF is one of the main causes of preventable mortality in pediatrics, its progression to respiratory failure is a highly prevalent condition in pediatric age, a condition that has a great impact on mortality, morbidity, and disability in our patients.

Severity and mortality of acute respiratory failure in pediatrics: A prospective multicenter cohort in Bogotá, Colombia

Vargas‐Acevedo,

Botero Marín,

Jaime Trujillo

et al. 2024

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Background and AimsAcute respiratory failure (ARF) is the most frequent cause of cardiorespiratory arrest and subsequent death in children worldwide. There have been limited studies regarding ARF in high altitude settings. The aim of this study was to calculate mortality and describe associated factors for severity and mortality in children with ARF.MethodsThe study was conducted within a prospective multicentric cohort that evaluated the natural history of pediatric ARF. For this analysis three primary outcomes were studied: mortality, invasive mechanical ventilation, and pediatric intensive care unit (PICU) length of stay. Eligible patients were children older than 1 month and younger than 18 years of age with respiratory difficulty at the time of admission. Patients who developed ARF were followed at the time of ARF, 48 h later, at the time of discharge, and at 30 and 60 days after discharge. It was conducted in the pediatric emergency, in‐hospital, and critical‐care services in three hospitals in Bogotá, Colombia, from April 2020 to June 2021.ResultsOut of a total of 685 eligible patients, 296 developed ARF for a calculated incidence of ARF of 43.2%. Of the ARF group, 90 patients (30.4%) needed orotracheal intubation, for a mean of 9.57 days of ventilation (interquartile range = 3.00–11.5). Incidence of mortality was 6.1% (n = 18). The associated factors for mortality in ARF were a history of a neurologic comorbidity and a higher fraction of inspired oxygen at ARF diagnosis. For PICU length of stay, the associated factors were age between 2 and 5 years of age, exposure to smokers, and respiratory comorbidity. Finally, for mechanical ventilation, the risk factors were obesity and being unstable at admission.ConclusionsARF is a common cause of morbidity and mortality in children. Understanding the factors associated with greater mortality and severity of ARF might allow earlier recognition and initiation of prompt treatment strategies.