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Risk Stratification in Pediatric Acute Respiratory Distress Syndrome

Objectives: The Pediatric Acute Lung Injury Consensus Conference developed a pediatric specifiic defiinition 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 pati...

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Main Authors: Wong, Judith Ju-Ming, Phan, Huu Phuc, Phumeetham, Suwannee, Ong, Jacqueline Soo May, Chor, Yek Kee, Qian, Suyun, Samransamruajkit, Rujipat, Anantasit, Nattachai, Gan, Chin Seng, Xu, Feng, Sultana, Rehena, Loh, Tsee Foong, Lee, Jan Hau
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Published: Lippincott, Williams & Wilkins 2017
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R Medicine
Online Access:http://eprints.um.edu.my/22796/
https://doi.org/10.1097/CCM.0000000000002623
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spelling my.um.eprints.227962019-10-22T03:26:57Z http://eprints.um.edu.my/22796/ Risk Stratification in Pediatric Acute Respiratory Distress Syndrome Wong, Judith Ju-Ming Phan, Huu Phuc Phumeetham, Suwannee Ong, Jacqueline Soo May Chor, Yek Kee Qian, Suyun Samransamruajkit, Rujipat Anantasit, Nattachai Gan, Chin Seng Xu, Feng Sultana, Rehena Loh, Tsee Foong Lee, Jan Hau R Medicine Objectives: The Pediatric Acute Lung Injury Consensus Conference developed a pediatric specifiic defiinition 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 defnition of PARDS is a useful tool for risk stratification. Lippincott, Williams & Wilkins 2017 Article PeerReviewed Wong, Judith Ju-Ming and Phan, Huu Phuc and Phumeetham, Suwannee and Ong, Jacqueline Soo May and Chor, Yek Kee and Qian, Suyun and Samransamruajkit, Rujipat and Anantasit, Nattachai and Gan, Chin Seng and Xu, Feng and Sultana, Rehena and Loh, Tsee Foong and Lee, Jan Hau (2017) Risk Stratification in Pediatric Acute Respiratory Distress Syndrome. Critical Care Medicine, 45 (11). pp. 1820-1828. ISSN 0090-3493 https://doi.org/10.1097/CCM.0000000000002623 doi:10.1097/CCM.0000000000002623
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic R Medicine
spellingShingle R Medicine
Wong, Judith Ju-Ming
Phan, Huu Phuc
Phumeetham, Suwannee
Ong, Jacqueline Soo May
Chor, Yek Kee
Qian, Suyun
Samransamruajkit, Rujipat
Anantasit, Nattachai
Gan, Chin Seng
Xu, Feng
Sultana, Rehena
Loh, Tsee Foong
Lee, Jan Hau
Risk Stratification in Pediatric Acute Respiratory Distress Syndrome
description Objectives: The Pediatric Acute Lung Injury Consensus Conference developed a pediatric specifiic defiinition 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 defnition of PARDS is a useful tool for risk stratification.
format Article
author Wong, Judith Ju-Ming
Phan, Huu Phuc
Phumeetham, Suwannee
Ong, Jacqueline Soo May
Chor, Yek Kee
Qian, Suyun
Samransamruajkit, Rujipat
Anantasit, Nattachai
Gan, Chin Seng
Xu, Feng
Sultana, Rehena
Loh, Tsee Foong
Lee, Jan Hau
author_facet Wong, Judith Ju-Ming
Phan, Huu Phuc
Phumeetham, Suwannee
Ong, Jacqueline Soo May
Chor, Yek Kee
Qian, Suyun
Samransamruajkit, Rujipat
Anantasit, Nattachai
Gan, Chin Seng
Xu, Feng
Sultana, Rehena
Loh, Tsee Foong
Lee, Jan Hau
author_sort Wong, Judith Ju-Ming
title Risk Stratification in Pediatric Acute Respiratory Distress Syndrome
title_short Risk Stratification in Pediatric Acute Respiratory Distress Syndrome
title_full Risk Stratification in Pediatric Acute Respiratory Distress Syndrome
title_fullStr Risk Stratification in Pediatric Acute Respiratory Distress Syndrome
title_full_unstemmed Risk Stratification in Pediatric Acute Respiratory Distress Syndrome
title_sort risk stratification in pediatric acute respiratory distress syndrome
publisher Lippincott, Williams & Wilkins
publishDate 2017
url http://eprints.um.edu.my/22796/
https://doi.org/10.1097/CCM.0000000000002623
_version_ 1648736213684715520
score 13.211869

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