Acute Respiratory Distress Syndrome in Children With Lower Respiratory Tract Infection Requiring Invasive Mechanical Ventilation: Post Hoc Analysis of the 2019-2020 Bronchiolitis and Codetection Cohort.
Benjamin R White, Lee Polikoff, Robin Alexander, Benjamin R Baer, Alexandre T Rotta, Sebastián González-Dambrauskas, Ledys M Izquierdo, Pablo Castellani, Christopher M Watson, Ryan A Nofziger, Steven Pon, Todd Karsies, Steven L Shein
{"title":"Acute Respiratory Distress Syndrome in Children With Lower Respiratory Tract Infection Requiring Invasive Mechanical Ventilation: Post Hoc Analysis of the 2019-2020 Bronchiolitis and Codetection Cohort.","authors":"Benjamin R White, Lee Polikoff, Robin Alexander, Benjamin R Baer, Alexandre T Rotta, Sebastián González-Dambrauskas, Ledys M Izquierdo, Pablo Castellani, Christopher M Watson, Ryan A Nofziger, Steven Pon, Todd Karsies, Steven L Shein","doi":"10.1097/PCC.0000000000003712","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Bronchiolitis and other lower respiratory tract infections (LRTIs) are the most common causes of pediatric respiratory failure. There is insufficient evidence characterizing pediatric acute respiratory distress syndrome (PARDS) in young children with LRTI to inform clinical management. We aimed to describe the prevalence and clinical characteristics of children intubated for LRTI and meeting PARDS criteria.</p><p><strong>Design: </strong>We performed a post hoc analysis of data from the Bronchiolitis And COdetectioN (BACON) study, an international prospective observational study of critical bronchiolitis. We compared PARDS subjects (meeting criteria the first full calendar day following intubation) to non-PARDS subjects.</p><p><strong>Setting: </strong>Forty-eight international PICUs recruiting to the BACON study, from December 2019 to November 2020.</p><p><strong>Patients: </strong>Children younger than 2 years old, requiring mechanical ventilation for acute LRTI.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Complete data were available for 571 children. Day 1 PARDS was diagnosed in 240 subjects(42%) and associated with increased mortality (7.9% vs. 2.7%; p = 0.023), greater duration of invasive ventilation (165 hr [interquartile range, 112-251 hr] vs. 135 hr [76-204 hr]; p < 0.001), and PICU length of stay (11 d [7-16 d] vs. 8 d [5-13 d]; p < 0.001). In our multivariable competing risk model, the presence of PARDS on day 1 was causally related to a prolonged duration of mechanical ventilation with the probability of extubation at 7 days for those with PARDS equal to 49% (44-54%) compared with 64% (59-69%) for those without PARDS.</p><p><strong>Conclusions: </strong>PARDS development was common in this critical bronchiolitis cohort, resulted in a longer duration of mechanical ventilation, and was associated with increased mortality and PICU length of stay. Prospective studies are needed to elucidate the optimal management of critical bronchiolitis.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e600-e610"},"PeriodicalIF":4.0000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PCC.0000000000003712","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/6 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: Bronchiolitis and other lower respiratory tract infections (LRTIs) are the most common causes of pediatric respiratory failure. There is insufficient evidence characterizing pediatric acute respiratory distress syndrome (PARDS) in young children with LRTI to inform clinical management. We aimed to describe the prevalence and clinical characteristics of children intubated for LRTI and meeting PARDS criteria.
Design: We performed a post hoc analysis of data from the Bronchiolitis And COdetectioN (BACON) study, an international prospective observational study of critical bronchiolitis. We compared PARDS subjects (meeting criteria the first full calendar day following intubation) to non-PARDS subjects.
Setting: Forty-eight international PICUs recruiting to the BACON study, from December 2019 to November 2020.
Patients: Children younger than 2 years old, requiring mechanical ventilation for acute LRTI.
Interventions: None.
Measurements and main results: Complete data were available for 571 children. Day 1 PARDS was diagnosed in 240 subjects(42%) and associated with increased mortality (7.9% vs. 2.7%; p = 0.023), greater duration of invasive ventilation (165 hr [interquartile range, 112-251 hr] vs. 135 hr [76-204 hr]; p < 0.001), and PICU length of stay (11 d [7-16 d] vs. 8 d [5-13 d]; p < 0.001). In our multivariable competing risk model, the presence of PARDS on day 1 was causally related to a prolonged duration of mechanical ventilation with the probability of extubation at 7 days for those with PARDS equal to 49% (44-54%) compared with 64% (59-69%) for those without PARDS.
Conclusions: PARDS development was common in this critical bronchiolitis cohort, resulted in a longer duration of mechanical ventilation, and was associated with increased mortality and PICU length of stay. Prospective studies are needed to elucidate the optimal management of critical bronchiolitis.
目的：毛细支气管炎和其他下呼吸道感染（LRTIs）是儿童呼吸衰竭最常见的原因。目前尚没有足够的证据表明小儿急性呼吸窘迫综合征（PARDS）在患有下呼吸道感染的幼儿中具有特征，从而为临床管理提供信息。我们的目的是描述符合PARDS标准的LRTI患儿插管的患病率和临床特征。设计：我们对来自毛细支气管炎和COdetectioN （BACON）研究的数据进行了事后分析，这是一项针对重症毛细支气管炎的国际前瞻性观察研究。我们将PARDS受试者（插管后第一个完整日历日符合标准）与非PARDS受试者进行比较。背景：2019年12月至2020年11月，BACON研究招募48名国际picu。患者：2岁以下儿童，急性下呼吸道感染需要机械通气。干预措施:没有。测量和主要结果：571名儿童获得完整数据。240名受试者（42%）在第1天诊断出PARDS，并与死亡率增加相关(7.9% vs. 2.7%；P = 0.023)，有创通气持续时间更长(165小时[四分位数间距，112-251小时]vs. 135小时[76-204小时]；p < 0.001)， PICU住院时间(11 d [7-16 d] vs. 8 d [5-13 d]；P < 0.001)。在我们的多变量竞争风险模型中，第1天PARDS的存在与机械通气持续时间的延长有因果关系，PARDS患者在第7天拔管的概率为49%(44-54%)，而没有PARDS的患者为64%（59-69%）。结论：PARDS在重症细支气管炎队列中很常见，导致机械通气持续时间更长，并与死亡率和PICU住院时间增加相关。需要前瞻性研究来阐明危重细支气管炎的最佳治疗方法。
期刊介绍：
Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
