Severity and Mortality Predictors of Pediatric Acute Respiratory Distress Syndrome According to the Pediatric Acute Lung Injury Consensus Conference Definition

Abstract

Objectives: The objective of this study was to assess the prevalence, severity, and outcomes of pediatric acute respiratory distress syndrome in a resource-limited country. In addition, we sought to explore the predisposing factors that predicted the initial severity, a change from mild to moderate-severe severity, and mortality. Design: Retrospective study. Setting: PICU in Songklanagarind Hospital, Songkhla, Thailand. Patients: Children 1 month to 15 years old with acute respiratory failure admitted to the PICU from January 2013 to December 2016. Interventions: None. Measurements and Main Results: From a total of 1,738 patients admitted to PICU, 129 patients (prevalence 7.4%) were diagnosed as pediatric acute respiratory distress syndrome using the Pediatric Acute Lung Injury Consensus Conference definition. The patients were categorized by severity. Fifty-seven patients (44.2%) were mild, 35 (27.1%) were moderate, and 37 (28.1%) were severe. After multivariable analysis was performed, factors significantly associated with moderate to severe disease at the initial diagnosis were Pediatric Risk of Mortality III score (odds ratio, 1.08; 95% CI, 1.03–1.15; p = 0.004), underlying oncologic/hematologic disorder (odds ratio, 0.32; 95% CI, 0.12–0.77; p = 0.012), and serum albumin level (odds ratio, 0.46; 95% CI, 0.27–0.80; p = 0.006), whereas underlying oncologic/hematologic disorder (odds ratio, 5.33; 95% CI, 1.33–21.4) and hemoglobin (odds ratio, 0.63; 95% CI, 0.44–0.89) predicted the progression of this syndrome within 7 days. The 30-day all-cause mortality rate was 51.2% (66/129). The predictors of mortality were the Pediatric Risk of Mortality III score (odds ratio, 1.12; 95% CI, 1.02–1.24; p = 0.017), underlying oncologic/hematologic disorder (odds ratio, 7.81; 95% CI, 2.18–27.94; p = 0.002), receiving systemic steroids (odds ratio, 4.04; 95% CI, 1.25–13.03; p = 0.019), having air leak syndrome (odds ratio, 5.45; 95% CI, 1.57–18.96; p = 0.008), and presenting with multiple organ dysfunction (odds ratio, 7.41; 95% CI, 2.00–27.36; p = 0.003). Conclusions: The prevalence and mortality rate of pediatric acute respiratory distress syndrome in a developing country are high. The oncologic/hematologic comorbidity had a significant impact on the severity of progression and mortality.

Natural product derived phytochemicals in managing acute lung injury by multiple mechanisms

“…A retrospective cohort study performed by researchers at the University of Washington reported that morbidity and mortality among 146,058 patients <18 years in ICUs during 2007–2016 were 1.8 % and 20 %, respectively [ 4 ]. A study in Thailand found that mortality and morbidity of the 1738 patients <15 years in pediatric ICUs (PICUs) for 2013–2016 were as high as 7.4 % and 51.2 %, respectively [ 5 ]. Additionally, an international observational study performed in total 145 PICUs from 27 countries for 2016–2017 reported that mortality and morbidity of the 23,280 patients were 3.2 % and 17 %, respectively [ 6 ].…”

Protective effect of Chrysanthemum morifolium Ramat. ethanol extract on lipopolysaccharide induced acute lung injury in mice

“…Through the total ion chromatogram of CEE analysis, we have totally identified 12 components (Fig. 5) from CEE, they are neochlorogenic acid (1), chlorogenic acid (2), caffeic acid (3), 1,3-dicaffeoylquinic acids (4), cynaroside (5), isochlorogenic acid C (6), isochlorogenic acid A (7), isochlorogenic acid B (8), linarin (9), luteolin (10), apigenin (11), acacetin (12). We also compared the chromatograph peaks of the mixed standard compounds and the samples of CEE (Fig.…”

“…In 1992, the American Thoracic Society (ATS) and the European Society of Critical Diseases (ESICM) changed ARDS (adult respiratory distress syndrome) to acute, and divided it into two parts: ALI and ARDS [3]. At the same time, the causes of ALI/ARDS were classified into two major factors: direct lung injury and indirect lung injury [4][5][6]. A large number of clinical studies have shown that Gram-negative bacilli infection is the most common cause of ALI induction and is one of the main causes of death [7,8].…”

HFOV in Pediatric ARDS: Viable or Vestigial?

“…Pediatric acute respiratory distress syndrome (PARDS) is associated with significant mortality [1], more so in the low middleincome countries (LMIC) [2][3][4][5]. Furthermore, mortality is proportional to the severity of ARDS; 1-15% for mild and moderate ARDS and 33% for severe ARDS [6].…”

“…In developing countries, ARDS mortality is usually contributed by the non-pulmonary organ involvement, independent of the type of ventilation [2,3]. Of these acute kidney injury and fluid overload are a lethal combination [18,19].…”