Your browser doesn't support javascript.
loading
Immunocompromised-Associated Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study.
Gertz, Shira J; Bhalla, Anoopindar; Chima, Ranjit S; Emeriaud, Guillaume; Fitzgerald, Julie C; Hsing, Deyin D; Jeyapalan, Asumthia S; Pike, Francis; Sallee, Colin J; Thomas, Neal J; Yehya, Nadir; Rowan, Courtney M.
Afiliação
  • Gertz SJ; Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, NJ.
  • Bhalla A; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles and University of Southern California, Los Angeles, CA.
  • Chima RS; Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH.
  • Emeriaud G; Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal, QC, Canada.
  • Fitzgerald JC; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA.
  • Hsing DD; Department of Pediatrics, New York Presbyterian Hospital and Weill Cornell Medical College, New York, NY.
  • Jeyapalan AS; Division of Critical Care Medicine, Department of Pediatrics, University of Miami, Miami, FL.
  • Pike F; Department of Biostatistics, Indiana University, Indianapolis, IN.
  • Sallee CJ; Division of Pediatric Critical Care, Department of Pediatrics, UCLA Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.
  • Thomas NJ; Division of Pediatric Critical Care Medicine, Department of Pediatrics and Public Health Science, Penn State Hershey Children's Hospital, Hershey, PA.
  • Yehya N; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA.
  • Rowan CM; Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at IU Health, Indianapolis, IN.
Pediatr Crit Care Med ; 25(4): 288-300, 2024 Apr 01.
Article em En | MEDLINE | ID: mdl-38236083
ABSTRACT

OBJECTIVES:

To characterize immunocompromised-associated pediatric acute respiratory distress syndrome (I-PARDS) and contrast it to PARDS.

DESIGN:

This is a secondary analysis of the 2016-2017 PARDS incidence and epidemiology (PARDIE) study, a prospective observational, cross-sectional study of children with PARDS.

SETTING:

Dataset of 145 PICUs across 27 countries. PATIENTS During 10 nonconsecutive weeks (from May 2016 to June 2017), data about immunocompromising conditions (ICCs, defined as malignancy, congenital/acquired immunodeficiency, posttransplantation, or diseases requiring immunosuppression) were collected.

INTERVENTIONS:

None. MEASUREMENTS AND MAIN

RESULTS:

Of 708 subjects, 105 (14.8%) had ICC. Before the development of I-PARDS, those with ICC were more likely to be hospitalized (70% vs. 35%, p < 0.001), have more at-risk for PARDS ( p = 0.046), and spent more hours at-risk (20 [interquartile range, IQR 8-46] vs. 11 [IQR 4-33], [ p = 0.002]). Noninvasive ventilation (NIV) use was more common in those with ICC ( p < 0.001). Of those diagnosed with PARDS on NIV ( n = 161), children with ICC were more likely to be subsequently intubated ( n = 28/40 [70%] vs n = 53/121 [44%], p = 0.004). Severe PARDS was more common (32% vs 23%, p < 0.001) in I-PARDS. Oxygenation indices were higher at diagnosis and had less improvement over the first 3 days of PARDS ( p < 0.001). Children with I-PARDS had greater nonpulmonary organ dysfunction. Adjusting for Pediatric Risk of Mortality IV and oxygenation index, children with I-PARDS had a higher severity of illness-adjusted PICU mortality (adjusted hazard ratio 3.0 [95% CI, 1.9-4.7] p < 0.001) and were less likely to be extubated alive within 28 days (subdistribution hazard ratio 0.47 [95% CI, 0.31-0.71] p < 0.001).

CONCLUSIONS:

I-PARDS is a unique subtype of PARDS associated with hospitalization before diagnosis and increased time at-risk for PARDS, NIV use, hypoxia, nonpulmonary organ dysfunction, and mortality. The opportunity for early detection and intervention seems to exist. Dedicated study in these patients is imperative to determine if targeted interventions will benefit these unique patients with the ultimate goal of improving outcomes.
Assuntos

Texto completo: 1 Bases de dados: MEDLINE Assunto principal: Síndrome do Desconforto Respiratório / Insuficiência de Múltiplos Órgãos Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies / Screening_studies Limite: Child / Humans Idioma: En Revista: Pediatr Crit Care Med Assunto da revista: PEDIATRIA / TERAPIA INTENSIVA Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Bases de dados: MEDLINE Assunto principal: Síndrome do Desconforto Respiratório / Insuficiência de Múltiplos Órgãos Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies / Screening_studies Limite: Child / Humans Idioma: En Revista: Pediatr Crit Care Med Assunto da revista: PEDIATRIA / TERAPIA INTENSIVA Ano de publicação: 2024 Tipo de documento: Article