Sepsis-related pediatric acute respiratory distress syndrome

Anantasit, Nattachai; Prasertsan, Pharsai; Walanchapruk, Suchanuch; Roekworachai, Koonkoaw; Samransamruajkit, Rujipat; Vaewpanich, Jarin

doi:10.4103/tjem.tjem_237_22

Turkish Journal of Emergency Medicine

2023

DOI: 10.4103/tjem.tjem_237_22

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Sepsis-related pediatric acute respiratory distress syndrome

Nattachai Anantasit

Pharsai Prasertsan

Suchanuch Walanchapruk

et al.

Abstract: OBJECTIVES: This study aimed to compare the risk factors and outcomes for organ dysfunction between sepsis-related Pediatric acute respiratory distress syndrome (PARDS) and nonsepsis PARDS. METHODS: We prospective cohort recruited intubated patients with PARDS at four tertiary care centers in Thailand. The baseline characteristics, mechanical ventilation, fluid balance, and clinical outcomes were collected. The primary outcome was organ dysfunction. RESUL… Show more

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2024

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Cited by 3 publications

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Biomarker-Based Risk Stratification Tool in Pediatric Acute Respiratory Distress Syndrome: Single-Center, Longitudinal Validation in a 2014–2019 Cohort

Whitney,

Johnson,

Varisco

et al. 2024

Pediatric Critical Care Medicine

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Objectives: The Pediatric Acute Respiratory Distress Syndrome Biomarker Risk Model (PARDSEVERE) used age and three plasma biomarkers measured within 24 hours of pediatric acute respiratory distress syndrome (ARDS) onset to predict mortality in a pilot cohort of 152 patients. However, longitudinal performance of PARDSEVERE has not been evaluated, and it is unclear whether the risk model can be used to prognosticate after day 0. We, therefore, sought to determine the test characteristics of PARDSEVERE model and population over the first 7 days after ARDS onset. Design: Secondary unplanned post hoc analysis of data from a prospective observational cohort study carried out 2014–2019. Setting: University-affiliated PICU. Patients: Mechanically ventilated children with ARDS. Interventions: None. Measurements and Main Results: Between July 2014 and December 2019, 279 patients with ARDS had plasma collected at day 0, 266 at day 3 (11 nonsurvivors, two discharged between days 0 and 3), and 207 at day 7 (27 nonsurvivors, 45 discharged between days 3 and 7). The actual prevalence of mortality on days 0, 3, and 7, was 23% (64/279), 14% (38/266), and 13% (27/207), respectively. The PARDSEVERE risk model for mortality on days 0, 3, and 7 had area under the receiver operating characteristic curve (AUROC [95% CI]) of 0.76 (0.69–0.82), 0.68 (0.60–0.76), and 0.74 (0.65–0.83), respectively. The AUROC data translate into prevalence thresholds for the PARDSEVERE model for mortality (i.e., using the sensitivity and specificity values) of 37%, 27%, and 24% on days 0, 3, and 7, respectively. Negative predictive value (NPV) was high throughout (0.87–0.90 for all three-time points). Conclusions: In this exploratory analysis of the PARDSEVERE model of mortality risk prediction in a population longitudinal series of data from days 0, 3, and 7 after ARDS diagnosis, the diagnostic performance is in the “acceptable” category. NPV was good. A major limitation is that actual mortality is far below the prevalence threshold for such testing. The model may, therefore, be more useful in cohorts with higher mortality rates (e.g., immunocompromised, other countries), and future enhancements to the model should be explored.

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Biomarker-Based Risk Stratification Tool in Pediatric Acute Respiratory Distress Syndrome: Single-Center, Longitudinal Validation in a 2014–2019 Cohort

Whitney,

Johnson,

Varisco

et al. 2024

Pediatric Critical Care Medicine

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Acute respiratory distress syndrome in pediatric practice, diagnosis, and intensive care: A review

Aleksandrovich,

Pshenisnov,

Kolodyazhnaya

2024

Russian Journal of Pediatric Surgery, Anesthesia and Intensive

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Acute respiratory distress syndrome is one of the main causes of life-threatening complications and deaths in pediatric intensive care units. This study aimed to analyze the current features of epidemiology, risk factors, and outcomes of acute respiratory distress syndrome in children aged 1 months according to the literature. The analysis included 100 publications extracted from eLibrary and PubMed abstract databases. The search was performed using the following keywords: acute respiratory distress syndrome, epidemiology, pediatric, outcome, and control mechanical ventilation. After the initial study of abstracts, 64 articles containing previously published information were excluded from the review. The recommendations of the Pediatric Acute Lung Injury Consensus Conference, which were published in April 2023, were taken as the main source. The review presents current definitions, risk factors, and criteria for the severity of acute respiratory distress syndrome in pediatric practice, discusses in detail the features of invasive ventilation and adjuvant therapy, and pays special attention to infusion and transfusion therapy, nutrition, and sedation. One of the sections is devoted to monitoring the patient’s condition, assessing the effectiveness of gas exchange and hemodynamics, and emphasizing the importance of a dynamic assessment of delirium in patients and the readiness for extubation. The recommendations of Pediatric Acute Lung Injury Consensus Conference-2 for the treatment of acute respiratory distress syndrome in children make it possible to more accurately stratify the severity of the pathological process, identify patients at risk with a high probability of developing this syndrome, and begin timely protective respiratory support to restore lung parenchyma and optimize oxygen delivery and consumption.

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Features of Respiratory Failure in Premature Infants With Neonatal Sepsis

Teslitskyi,

Koloskova,

Bilous

et al. 2024

EUMJ

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Neonatal sepsis remains the main cause of morbidity and mortality in neonatal intensive care units. In particular, the share of sepsis in the structure of neonatal respiratory failure reaches 35.3%. At the same time, the search for sensitive indicators of the critical course of the acute respiratory distress syndrome against the background of the septic process remains relevant. Objective. To study the peculiarities of the course of respiratory failure in the dynamics of treatment of premature babies with neonatal sepsis, depending on the gestational age. Material and methods. To achieve this goal, in the conditions of the Neonatal Intensive Care Unit of the Regional Municipal Non-Commercial Enterprise "Chernivtsi Regional Children's Clinical Hospital" during 2021–2022 a comprehensive prospective study was conducted of 60 prematurely born patients with neonatal sepsis, which progressed with the phenomena of respiratory failure. Group I included 36 newborns (with gestational age up to and including 32 weeks), according to group II – 24 infants (gestational age > 32 weeks). Research results. Oxygen dependence was most clearly reflected by lower SpO2 indicators and, accordingly, the need to increase FiO2, which was explained by the immaturity of the respiratory system in children with a critically low gestational age. In ¾ of the newborns of the II clinical group, respiratory index exceeded 200 mmHg, and in the I clinical group this sign occurred only in every second patient: AR - 30.1%, RR – 1.9 (95% CI: 1.5–2.5), OR – 3.5 (95% CI: 1.9–6.5). It was established that with a critically short gestation period against the background of worse adaptation to extrauterine living conditions, clinical signs of respiratory distress, lower respiratory index and higher hypercarbia are more pronounced in babies with relatively comparable parameters of respiratory support. Conclusion. Clinical and paraclinical features of respiratory failure against the background of neonatal sepsis in prematurely born children consist of deeper disturbances of the gas composition of the blood, torpidity to measures of respiratory protection in newborns with a critically short gestation period, which is explained by the combined pathogenetic influence of the immaturity of the respiratory system and the aggressive influence of infectious and inflammatory process.

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Sepsis-related pediatric acute respiratory distress syndrome

Cited by 3 publications

References 28 publications

Biomarker-Based Risk Stratification Tool in Pediatric Acute Respiratory Distress Syndrome: Single-Center, Longitudinal Validation in a 2014–2019 Cohort

Biomarker-Based Risk Stratification Tool in Pediatric Acute Respiratory Distress Syndrome: Single-Center, Longitudinal Validation in a 2014–2019 Cohort

Acute respiratory distress syndrome in pediatric practice, diagnosis, and intensive care: A review

Features of Respiratory Failure in Premature Infants With Neonatal Sepsis

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