Nutritional Status and Mechanical Ventilation Practices in Pediatric Acute Respiratory Distress Syndrome: A Secondary Analysis of the 2017-2023 PARDSAsia Study.
Chen Yun Goh, Karen Ka Yan Leung, Jia Yueh Chong, Xuemei Zhu, Nattachai Anantasit, Lijia Fan, Chunfeng Liu, Louise Ngu, Kam Lun Ellis Hon, Jan Hau Lee, Wei Xu, Hiroshi Kurosawa, Dyah Kanya Wati, Rujipat Samransamruajkit, Li Huang, Muralidharan Jayashree, Yek Kee Chor, Hongxing Dang, Chin Seng Gan, Kah Min Pon, Chian Wern Tai, Phuc Huu Phan, Kazunori Aoki, Felix Liauw, Soo Lin Chuah, Suparyatha Ida Bagus Gede, Pei Chuen Lee, Jacqueline Soo May Ong, Siew Wah Lee, Chengsi Ong, Rehena Sultana, Judith Ju-Ming Wong
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引用次数: 0
Abstract
Objectives: In this non-prespecified secondary analysis of the PARDSAsia (NCT04068038) 2017-2023 dataset, we describe baseline nutrition status of children with pediatric acute respiratory distress syndrome (PARDS) and determine its association with positive end expiratory pressure (PEEP) during ventilation and mortality. We hypothesized that abnormal nutritional status was associated with adverse outcomes.
Design: The dataset included anthropometric and nutritional data, and body mass index (BMI) z scores were obtained using the World Health Organization standards. Underweight is BMI z score less than -1 and overweight is BMI z score greater than +1. PEEP and F io2 combinations, by the standard grid, in underweight, overweight and normal nutrition groups were compared. Cox proportional hazard regression tested the association between nutrition status and 60-day mortality.
Setting: Twenty-one PICUs across Asia, 2017-2023.
Patients: PARDSAsia patients met the 2015 International Guidelines for the Diagnosis and Management of PARDS (PALICC) criteria.
Interventions: None.
Measurements and main results: Overall, of 693 PARDSAsia patients, we included 625 cases comprising 261 of 625 (41.8%) underweight, 235 of 625 (37.6%) normal, and 129 of 625 (20.6%) overweight patients. Being underweight compared with normal or overweight status, was associated with younger median (interquartile range) age: respectively, 1.0 (0.3, 3.7) vs. 1.4 (0.5, 4.6) vs. 1.9 (0.7, 8.5) years ( p < 0.001). The prescription of PEEP was more conservative in patients who were underweight compared with patients of normal or overweight nutritional status: PEEP/F io2 combinations were, respectively, -1.7 (-3.3, 0.0) vs. -0.9 (-2.7, 0.0) vs. -0.6 (-1.8, 0.4) cm H 2 O below recommended grid value ( p < 0.001). Underweight nutritional status was associated with greater risk of 60-day mortality (adjusted hazard ratio 1.85 [95% CI, 1.14-3.01]).
Conclusions: Underweight nutritional status was prevalent among children within the PARDSAsia 2017-2023 dataset and was associated with poor clinical outcomes. The prescription of PEEP was more conservative in underweight patients compared with those with normal or overweight status.
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.
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