PP487 [Lung » pARDS]: PAEDIATRIC ACUTE RESPIRATORY DISTRESS SYNDROME (PARDS) IN SOUTH AFRICA – A MULTI-SITE POINT PREVALENCE STUDY

Abstract

BACKGROUND AND AIM: Pediatric Acute Respiratory Distress Syndrome (PARDS) is a frequent cause of hypoxic respiratory failure. A driving pressure greater than 15 cm/ H2O in adults is associated with poor outcomes. The pulmonary mechanics change in children and the threshold associated with poor outcomes is unknown. ObjectiveTo establish the driving pressure level associated with poor outcomes in children PARDS requiring invasive mechanical ventilation in Pediatric Intensive Care Units (PICU). METHOD:We conducted a prospective multicenter cohort in 12 PICU in Colombia. Patients included were between 1 month and 18 years of age with moderate to severe ARDS requiring PICU admission and mechanical ventilation, during February/2017 and November/2019. Median and interquartile range were used for quantitative variables, and absolute and relative values for qualitative variables. Demographic and clinical variables were compared according to mortality outcome with chi square or the Mann Whitney U test. A p<0.05 was considered statistically significant RESULTS:The cohort included 212 subjects, of which 62% were males. The median age was 11 months. Main diagnosis on admission was septic shock, present in 48% of subjects, followed by bacterial pneumonia (34%) and viral pneumonia (32%). Severe oxygenation disorder with a PaO 2 /FiO 2 <100 was present in 54% of subjects on admission. PaO 2 /FiO 2 within 100-199 were seen in 41% and close to 5% debuted with a mild oxygenation disorder CONCLUSIONS: A driving pressure >18 cm/H2O at 48 hours after mechanical ventilation in children with moderate to severe ARDS is associated with increased risk of poor outcomes. This risk progressively increases with greater driving pressures.

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