Post‐discharge respiratory outcomes of children with acute respiratory distress syndrome

Abstract

Objectives While long‐term sequelae of acute respiratory distress syndrome (ARDS) are well‐documented in adults, few studies reported post‐discharge respiratory complications in pediatric ARDS (PARDS) and none used the recent Pediatric Acute Lung Injury Consensus Conference (PALICC) diagnostic criteria. This study describes the respiratory symptoms, pulmonary function, and health resource use of PARDS survivors at 3 months post‐discharge. Design Retrospective study. Patient Selection Children less than 18 years admitted to the intensive care unit of Sainte‐Justine University Health Center from 1st September 2015 to 1st July 2017, and meeting PALICC diagnostic criteria for PARDS. Methods We evaluated 38 of the 44 children with PARDS in the follow‐up clinic at a mean (SD) of 3.4 (2.0) months post‐discharge for respiratory symptoms, age‐appropriate pulmonary function tests (spirometry or oscillometry, maximal respiratory pressures), and all‐cause emergency department (ED) visits or rehospitalizations since discharge. Results Fourteen (36.8%) had abnormal respiratory symptoms (most commonly cough between respiratory infections and wheezing), 7 of whom (18.4%) presented new respiratory symptoms since PARDS diagnosis. A mild‐to‐moderate restrictive pattern was observed in 3 of 10 patients who performed spirometry and mildly decreased maximal inspiratory pressures were noted in 2 of 8 patients who performed these maneuvers. Nine (23.7%) patients consulted in the ED and 4 (10.5%) were rehospitalized post‐discharge. Conclusions Despite our cohort's limited sample size, our findings suggest that a significant proportion of PARDS survivors experience abnormal respiratory symptoms, pulmonary function deficits, and recurrent problems requiring medical attention. Larger, multicenter studies are required to identify risk factors associated with poor post‐discharge outcomes among PARDS survivors.

Lung Mechanics of Mechanically Ventilated Patients With COVID-19: Analytics With High-Granularity Ventilator Waveform Data

“…Other pulmonary function parameters, such as PEF and MIP were also reduced by one third of the predicted value. Boucher and coworkers observed that the pulmonary function can be significantly compromised in pediatric ARDS in short follow-up period (31). In adult patients with general ARDS, the FVC can recover to 3.34 ± 0.77 and 3.78 ± 1.11 L at 1 and 6 months follow up (32), which is significantly higher than that in our study.…”

Posthospitalization follow‐up recommendations after pediatric critical illness due to respiratory failure

“…This determination was made by consensus among the authors based on literature describing the physical and emotional outcomes of PICU patients in each category and on the authors' clinical experience. 1,[3][4][5][6][7][8][9]14,[15][16][17] We then assessed the proportion of patients who were recommended to follow-up with each provider type:…”

“…Given the lack of consensus guidelines for recommended follow‐up after a general pediatric or PICU admission, the authors determined a priori the recommended providers we would anticipate patients in each population to have follow‐up appointments with. This determination was made by consensus among the authors based on literature describing the physical and emotional outcomes of PICU patients in each category and on the authors’ clinical experience 1,3‐9,14,15‐17 For respiratory failure patients, we assessed the proportion of patients who were recommended to follow‐up with primary care, pulmonology, and physical and occupational therapy. For patients who received ECMO, we assessed the proportion of patients who were recommended to follow‐up with primary care, pulmonology, physical and occupational therapy, physical medicine and rehabilitation, and neurology. For patients with tracheostomy, we assessed the proportion of patients who were recommended to follow‐up with primary care, pulmonology, physical and occupational therapy, physical medicine and rehabilitation, and otolaryngology. For all patients with respiratory failure, we examined the impact of a comorbid condition on admission and a new morbidity at discharge on the proportion of patients who were recommended to follow‐up with primary care, pulmonology, and physical and occupational therapy. For all patients with respiratory failure, we calculated the proportion of follow‐up recommended to be completed at community care center versus tertiary care center settings for those with primary care follow‐up only, specialty care follow‐up only, and both primary and specialty care follow‐up.…”

“…Given the lack of consensus guidelines for recommended follow‐up after a general pediatric or PICU admission, the authors determined a priori the recommended providers we would anticipate patients in each population to have follow‐up appointments with. This determination was made by consensus among the authors based on literature describing the physical and emotional outcomes of PICU patients in each category and on the authors’ clinical experience 1,3‐9,14,15‐17 …”

“…In a recent report of patients with pediatric acute respiratory distress syndrome, a third of patients had abnormal respiratory symptoms at 3 months after discharge. 16 Patients with a new morbidity at discharge had similar follow-up recommendations to those with intact survival with regard to primary care and pulmonology follow-up but were more often recommended to follow-up with physical therapy and occupational therapy. In the current study, while the majority of patients who received ECMO were appropriately recommended to follow-up with a primary care provider and physical therapist, only 55% were referred to see a pulmonologist.…”