Risk Stratification in Pediatric Acute Respiratory Distress Syndrome: A Multicenter Observational Study

Wong JJ 1 , Phan HP , Phumeetham S , Ong JSM , Chor YK , Qian S Show all authors , Samransamruajkit R , Anantasit N , Gan CS , Xu F , Sultana R , Loh TF , Lee JH , Pediatric Acute & Critical Care Medicine Asian Network (PACCMAN)

Affiliations 

  • 1 1Children's Intensive Care Unit, Department of Pediatric Subspecialities, KK Women's and Children's Hospital, Singapore. 2Duke-NUS Medical School, Singapore. 3Pediatric Intensive Care Unit, National Children's Hospital, Hanoi, Vietnam. 4Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 5Pediatric Intensive Care Unit, Department of Pediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore. 6Department of Pediatrics, Sarawak General Hospital, Kuching, Malaysia. 7Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, Beijing, China. 8Division of Pediatric Critical Care, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 9Pediatric Department, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 10Department of Pediatrics, University Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia. 11Children's Hospital of Chongqing Medical University, Chongqing, China. 12Center for Quantitative Medicine, Duke-NUS Medical School, Singapore
Crit Care Med, 2017 Jul 26.
PMID: 28749854 DOI: 10.1097/CCM.0000000000002623

Abstract

OBJECTIVES: The Pediatric Acute Lung Injury Consensus Conference developed a pediatric specific definition for acute respiratory distress syndrome (PARDS). In this definition, severity of lung disease is stratified into mild, moderate, and severe groups. We aim to describe the epidemiology of patients with PARDS across Asia and evaluate whether the Pediatric Acute Lung Injury Consensus Conference risk stratification accurately predicts outcome in PARDS.

DESIGN: A multicenter, retrospective, descriptive cohort study.

SETTING: Ten multidisciplinary PICUs in Asia.

PATIENTS: All mechanically ventilated children meeting the Pediatric Acute Lung Injury Consensus Conference criteria for PARDS between 2009 and 2015.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Data on epidemiology, ventilation, adjunct therapies, and clinical outcomes were collected. Patients were followed for 100 days post diagnosis of PARDS. A total of 373 patients were included. There were 89 (23.9%), 149 (39.9%), and 135 (36.2%) patients with mild, moderate, and severe PARDS, respectively. The most common risk factor for PARDS was pneumonia/lower respiratory tract infection (309 [82.8%]). Higher category of severity of PARDS was associated with lower ventilator-free days (22 [17-25], 16 [0-23], 6 [0-19]; p < 0.001 for mild, moderate, and severe, respectively) and PICU free days (19 [11-24], 15 [0-22], 5 [0-20]; p < 0.001 for mild, moderate, and severe, respectively). Overall PICU mortality for PARDS was 113 of 373 (30.3%), and 100-day mortality was 126 of 317 (39.7%). After adjusting for site, presence of comorbidities and severity of illness in the multivariate Cox proportional hazard regression model, patients with moderate (hazard ratio, 1.88 [95% CI, 1.03-3.45]; p = 0.039) and severe PARDS (hazard ratio, 3.18 [95% CI, 1.68, 6.02]; p < 0.001) had higher risk of mortality compared with those with mild PARDS.

CONCLUSIONS: Mortality from PARDS is high in Asia. The Pediatric Acute Lung Injury Consensus Conference definition of PARDS is a useful tool for risk stratification.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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