Differences Between Pulmonary and Extrapulmonary Pediatric Acute Respiratory Distress Syndrome: A Multicenter Analysis

Gan CS 1 , Wong JJ 2 , Samransamruajkit R 3 , Chuah SL 1 , Chor YK 4 , Qian S 5 Show all authors , Anantasit N 6 , Feng X 7 , Ong JSM 8 , Phuc PH 9 , Phumeetham S 10 , Sultana R 11 , Loh TF 2 , Lum LCS 1 , Lee JH 2 , Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN)

Affiliations 

  • 1 Pediatric Intensive Care Unit, Department of Pediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 2 Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore
  • 3 Division of Pediatric Critical Care, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • 4 Department of Pediatrics, Sarawak General Hospital, Kuching, Malaysia
  • 5 Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, Beijing, China
  • 6 Division of Pediatric Critical Care, Department of Pediatrics, Ramathibodi Hospital, Mahidol University. Bangkok, Thailand
  • 7 Pediatric Intensive Care, Children's Hospital of Chongqing Medical University, Chongqing, China
  • 8 Pediatric Intensive Care Unit, Department of Pediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
  • 9 Pediatric Intensive Care Unit, National Children's Hospital, Hanoi, Vietnam
  • 10 Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 11 Center for Quantitative Medicine, Duke-NUS Medical School, Singapore
Pediatr Crit Care Med, 2018 10;19(10):e504-e513.
PMID: 30036234 DOI: 10.1097/PCC.0000000000001667

Abstract

OBJECTIVES: Extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome are poorly described in the literature. We aimed to describe and compare the epidemiology, risk factors for mortality, and outcomes in extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome.

DESIGN: This is a secondary analysis of a multicenter, retrospective, cohort study. Data on epidemiology, ventilation, therapies, and outcomes were collected and analyzed. Patients were classified into two mutually exclusive groups (extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome) based on etiologies. Primary outcome was PICU mortality. Cox proportional hazard regression was used to identify risk factors for mortality.

SETTING: Ten multidisciplinary PICUs in Asia.

PATIENTS: Mechanically ventilated children meeting the Pediatric Acute Lung Injury Consensus Conference criteria for pediatric acute respiratory distress syndrome between 2009 and 2015.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Forty-one of 307 patients (13.4%) and 266 of 307 patients (86.6%) were classified into extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome groups, respectively. The most common causes for extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome were sepsis (82.9%) and pneumonia (91.7%), respectively. Children with extrapulmonary pediatric acute respiratory distress syndrome were older, had higher admission severity scores, and had a greater proportion of organ dysfunction compared with pulmonary pediatric acute respiratory distress syndrome group. Patients in the extrapulmonary pediatric acute respiratory distress syndrome group had higher mortality (48.8% vs 24.8%; p = 0.002) and reduced ventilator-free days (median 2.0 d [interquartile range 0.0-18.0 d] vs 19.0 d [0.5-24.0 d]; p = 0.001) compared with the pulmonary pediatric acute respiratory distress syndrome group. After adjusting for site, severity of illness, comorbidities, multiple organ dysfunction, and severity of acute respiratory distress syndrome, extrapulmonary pediatric acute respiratory distress syndrome etiology was not associated with mortality (adjusted hazard ratio, 1.56 [95% CI, 0.90-2.71]).

CONCLUSIONS: Patients with extrapulmonary pediatric acute respiratory distress syndrome were sicker and had poorer clinical outcomes. However, after adjusting for confounders, it was not an independent risk factor for mortality.

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

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