Oxygenation Index in the First 24 Hours after the Diagnosis of Acute Respiratory Distress Syndrome as a Surrogate Metric for Risk Stratification in Children

Kim, Soo Yeon; Kim, Byuhree; Choi, Sun Ha; Kim, Jong Deok; Sol, In Suk; Kim, Min Jung; Kim, Yoon Hee; Kim, Kyung Won; Kim, Kyu-Earn

doi:10.4266/acc.2018.00136

Cited by 5 publications

(7 citation statements)

References 29 publications

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“…Remarkably, the C RS of C-PARDS was close to the C RS reported in other pediatric cohorts of viral PARDS 31 and other restrictive lung diseases 38 . Regarding outcomes, mortality was not statistically different between C-PARDS and MIS-PARDS.…”

Section: Discussionsupporting

confidence: 84%

“…39,40 It is very interesting that in the current study, previous known variables associated with mortality in PARDS and in pediatric critical COVID-19, like organ failures and hypoxemia severity, were not different between survivors and non-survivors. 37,38,[41][42][43][44][45] A surprising result was the difference in the respiratory mechanics between the clinical phenotypes. The cohort fulfilled PARDS and critical COVID-19 criteria but with different characteristics.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pediatric ARDS phenotypes in critical COVID-19: implications for therapies and outcomes

Domínguez-Rojas

Luna-Delgado²,

Caqui-Vilca

et al. 2022

Preprint

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Purposeto describe lung mechanics in Pediatric Acute Respiratory Disease Syndrome (PARDS) associated with COVID-19. We hypothesize two phenotypes according to respiratory system mechanics and clinical diagnosis.Methodsa concurrent multicenter observational study was performed, analyzing clinical variables and pulmonary mechanics of PARDS associated with COVID-19 in 4 Pediatric intensive care units (PICUs) of Perú. Subgroup analysis included PARDS associated with multisystem inflammatory syndrome in children (MIS-C), MIS-PARDS, and PARDS with COVID-19 primary respiratory infection, C-PARDS. In addition, receiver operator curve analysis (ROC) for mortality was performed.Results30 patients were included. Age was 7.5(4-11) years, 60% male, and mortality 23%. 47% corresponded to MIS-PARDS and 53% to C-PARDS phenotypes. C-PARDS had positive RT-PCR in 67% and MIS-PARDS none (p<0.001). C-PARDS group had more profound hypoxemia (P/Fratio<100, 86%vs38%,p<0.01) and higher driving-pressure (DP) [14(10-22)vs10(10-12)cmH2O], and lower compliance of the respiratory system (CRS)[0.5(0.3-0.6)vs 0.7(0.6-0.8)ml/kg/cmH2O] compared to MIS-PARDS (all p<0.05). ROC-analysis for mortality showed that DP had the best performance [AUC 0.91(95%CI0.81-1.00), with the best cut-point of 15 cmH2O (100% sensitivity and 87% of specificity). Mortality in C-PARDS was 38% and 7% in MIS-PARDS(p=0.09). MV free-days were 12(0-23) in C-PARDS and 23(21-25) in MIS-PARDS(p=0.02)Conclusioncritical pediatric COVID-19 is heterogeneous in children. COVID-19 PARDS had two phenotypes with distinctive pulmonary mechanics features. Characteristics of C-PARDS are like a classic primary PARDS, while a decoupling between compliance and hypoxemia was more frequent in MIS-PARDS. In addition, C-PARDS had fewer MV free-days. DP ≥ 15 cmH2O had the best performance of the quasi-static calculations to discriminate for mortality. Standardized pulmonary mechanics measurements in PARDS might reveal essential information to tailor the ventilatory strategy in pediatric critical COVID-19.‘Take-home message’PARDS associated with COVID-19 have two different phenotypes based on clinical diagnosis and pulmonary mechanics.C-PARDS group was characterized as a classic moderate to severe primary ARDS. A decoupling between compliance and hypoxemia was more frequent in MIS-PARDS. Regarding outcomes, C-PARDS had less VFD and a trend toward higher mortality.Data from the quasi-static calculations were associated with mortality; DP≥ 15 cmH2O was the best discriminator.Standardized pulmonary mechanics measurements in PARDS might reveal essential information to tailor the ventilatory strategy, characterizing different phenotypes and parameters associated with outcomes.TweetLung mechanics help to differentiate two different phenotypes in PARDS associated with COVID-19. C-PARDS associated with respiratory infection, and MIS-PARDS, associated with MIS-C. Also, lung mechanics variables were associated with mortality, being DP ≥ 15 cmH2O the best discriminator.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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Pediatric ARDS phenotypes in critical COVID-19: implications for therapies and outcomes

Domínguez-Rojas

Luna-Delgado²,

Caqui-Vilca

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…Pediatric patients with ARDS differ from adult patients with ARDS in terms of characteristics such as etiologic factors, pathophysiology, clinical course, and outcomes. [1][2][3][4][5][6][7] Since ARDS was first described in 1967, 8 numerous studies have been performed addressing various clinical issues including definitions, diagnostic criteria, classification, risk factors for mortality, and therapeutic strategies to improve clinical outcomes. [9][10][11][12][13][14][15][16] However, such investigations have mainly addressed adult ARDS.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Prognostic Factors Between Direct and Indirect Pediatric ARDS

Kim

Park

et al. 2020

Respir Care

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BACKGROUND: Pediatric ARDS is a heterogeneous disease entity with high morbidity and mortality. In this study, we categorized pediatric ARDS by direct and indirect initial triggering events and identified characteristics of survivors and nonsurvivors in these 2 subtypes. METHODS: This was a single-center, retrospective, observational study that included critically ill subjects with pediatric ARDS (age 1 month to 18 y) who had undergone mechanical ventilation support and had been admitted to our 14-bed, multidisciplinary, tertiary pediatric medical ICU between January 2010 and March 2019. RESULTS: A total of 162 subjects with pediatric ARDS were included. The direct ARDS subtype accounted for 128 cases, and 34 cases were classified as indirect ARDS. The most common initiating events were pneumonia and sepsis for direct and indirect ARDS, respectively. Subjects with indirect ARDS had higher serum lactate levels, greater Pediatric Risk of Mortality III (PRISM III) and Pediatric Sequential Organ Failure Assessment (pSOFA) scores than those with direct ARDS (P < .05). Nonsurvivors with the direct subtype had worse mechanical ventilation-related parameters, including F IO 2 , PEEP, P aw , peak inspiratory pressure, oxygenation index, and P aO 2 /F IO 2 ratio than survivors with the direct subtype. The likelihood of mortality rose with the severity of ARDS in association with the direct subtype but not with the indirect subtypes. Among children with indirect ARDS, lactate levels and pSOFA scores were significantly higher among nonsurvivors than survivors. CONCLUSIONS: Direct and indirect pediatric ARDS had distinct clinical characteristics, especially in terms of prognostic factors. Variables related to mechanical ventilation were significantly associated with mortality among subjects with direct pediatric ARDS, but not among subjects with indirect pediatric ARDS. Thus, this study provides evidence of the potential benefit of categorizing patients with pediatric ARDS by subtype for evaluating prognostic factors and developing adjusted management strategies to improve clinical outcomes.

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“…The PALICC definition is unclear as to when to stratify hypoxemia severity: at the time of or following PARDS diagnosis 9,25–28 . The PARDIE study 9 suggested that hypoxemia severity stratification at 6 h after PARDS diagnosis could better discriminate pediatric mortality while other studies 25–28 had advocated waiting for 12–24 h after PARDS diagnosis for hypoxemia severity stratification. The PALICC definition recommends OI measurements at the onset of PARDS and at 24, 48, and 72 h after onset, but superiority was not evaluated 15,25 .…”

Section: Discussionmentioning

confidence: 99%

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

Zhou

Tang

et al. 2022

Pediatric Pulmonology

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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.

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Oxygenation Index in the First 24 Hours after the Diagnosis of Acute Respiratory Distress Syndrome as a Surrogate Metric for Risk Stratification in Children

Cited by 5 publications

References 29 publications

Pediatric ARDS phenotypes in critical COVID-19: implications for therapies and outcomes

Pediatric ARDS phenotypes in critical COVID-19: implications for therapies and outcomes

Comparison of Prognostic Factors Between Direct and Indirect Pediatric ARDS

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

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