Yolanda M López-Fernández, Amelia Martínez-de-Azagra, Susana B Reyes-Domínguez, Ana Gómez-Zamora, Laura Herrera-Castillo, Ana Coca-Pérez, Julio Parrilla-Parrilla, Alberto Medina, Juan P García-Iñiguez, Marta Brezmes-Raposo, Alexandra Hernández-Yuste, Ana M Llorente de la Fuente, Ignacio Ibarra de la Rosa, José S León-González, Javier Trastoy-Quintela, David Arjona-Villanueva, Jesús M González-Martín, Tamas Szakmany, Jesús Villar
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The secondary outcomes were the prevalence of IMV with PARDS (IMV-PARDS) and the use of adjunctive therapies. There were 6545 PICU admissions: 1374 (21%) underwent IMV and 181 (2.8%) had AHRF. Ninety-one patients (1.4% of PICU admissions, 6.6% of IMV cases, and 50.3% of AHRF cases) met the Second Pediatric Acute Lung Injury Consensus Conference IMV-PARDS criteria. At baseline, mean (± sd) tidal volume was 7.4 ± 1.8 mL/kg ideal body weight, PEEP 8.4 ± 3.1 cm H2O, Fio2 0.68 ± 0.23, and plateau pressure 25.7 ± 6.3 cm H2O. Unlike patients with PARDS, adjunctive therapies were used infrequently in non-PARDS AHRF patients. AHRF patients without PARDS had more ventilator-free days than PARDS patients (16.4 ± 9.4 vs. 11.2 ± 10.5; p = 0.002). All-cause PICU mortality in AHRF cases was higher in PARDS vs. non-PARDS patients (30.8% [95% CI, 21.5-41.3] vs. (14.4% [95% CI, 7.9-23.4]; p = 0.01).</p><p><strong>Conclusions: </strong>In our 2019-2021 PICU population, the prevalence of AHRF is 2.8% of IMV cases. Of such patients, the prevalence of PARDS was 50.3%, and there was a 30.8% mortality, which was higher than in cases of AHRF without PARDS.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0000,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Prevalence and Outcome of Acute Hypoxemic Respiratory Failure (PANDORA) Study in Mechanically Ventilated Children: Prospective Multicenter Epidemiology in Spain, 2019-2021.\",\"authors\":\"Yolanda M López-Fernández, Amelia Martínez-de-Azagra, Susana B Reyes-Domínguez, Ana Gómez-Zamora, Laura Herrera-Castillo, Ana Coca-Pérez, Julio Parrilla-Parrilla, Alberto Medina, Juan P García-Iñiguez, Marta Brezmes-Raposo, Alexandra Hernández-Yuste, Ana M Llorente de la Fuente, Ignacio Ibarra de la Rosa, José S León-González, Javier Trastoy-Quintela, David Arjona-Villanueva, Jesús M González-Martín, Tamas Szakmany, Jesús Villar\",\"doi\":\"10.1097/PCC.0000000000003743\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To describe the epidemiology and outcome of children with acute hypoxemic respiratory failure (AHRF) and/or pediatric acute respiratory distress syndrome (PARDS).</p><p><strong>Design: </strong>Prospective, observational study in six nonconsecutive 2-month blocks form October 2019 to September 2021.</p><p><strong>Setting: </strong>A network of 22 PICUs in Spain.</p><p><strong>Patients: </strong>Consecutive children (7 d to 15 yr old) with a diagnosis of AHRF, defined by Pao2/Fio2 ratio less than or equal to 300 mm Hg, who needed invasive mechanical ventilation (IMV) using positive end-expiratory pressure (PEEP) greater than or equal to 5 cm H2O and Fio2 greater than or equal to 0.3.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcomes were AHRF prevalence and PICU mortality. The secondary outcomes were the prevalence of IMV with PARDS (IMV-PARDS) and the use of adjunctive therapies. There were 6545 PICU admissions: 1374 (21%) underwent IMV and 181 (2.8%) had AHRF. Ninety-one patients (1.4% of PICU admissions, 6.6% of IMV cases, and 50.3% of AHRF cases) met the Second Pediatric Acute Lung Injury Consensus Conference IMV-PARDS criteria. At baseline, mean (± sd) tidal volume was 7.4 ± 1.8 mL/kg ideal body weight, PEEP 8.4 ± 3.1 cm H2O, Fio2 0.68 ± 0.23, and plateau pressure 25.7 ± 6.3 cm H2O. Unlike patients with PARDS, adjunctive therapies were used infrequently in non-PARDS AHRF patients. AHRF patients without PARDS had more ventilator-free days than PARDS patients (16.4 ± 9.4 vs. 11.2 ± 10.5; p = 0.002). 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引用次数: 0
摘要
目的：描述急性低氧性呼吸衰竭（AHRF）和/或儿科急性呼吸窘迫综合征（PARDS）患儿的流行病学和预后。设计：前瞻性、观察性研究，从2019年10月至2021年9月，为期6个非连续的2个月。背景：在西班牙有22个picu网络。患者：诊断为AHRF的连续儿童（7天至15岁），Pao2/Fio2比小于或等于300 mm Hg，需要有创机械通气（IMV），呼气末正压（PEEP）大于或等于5 cm H2O， Fio2大于或等于0.3。干预措施:没有。测量方法和主要结果：主要结果为AHRF患病率和PICU死亡率。次要结局是伴有PARDS的IMV患病率（IMV-PARDS）和辅助治疗的使用。6545例PICU入院：1374例（21%）行IMV， 181例（2.8%）行AHRF。91例患者（1.4%的PICU入院，6.6%的IMV病例和50.3%的AHRF病例）符合第二届儿科急性肺损伤共识会议IMV- pards标准。基线时，平均潮气量（±sd）为7.4±1.8 mL/kg理想体重，PEEP为8.4±3.1 cm H2O， Fio2为0.68±0.23，平台压为25.7±6.3 cm H2O。与PARDS患者不同，非PARDS AHRF患者很少使用辅助治疗。无PARDS的AHRF患者比PARDS患者无呼吸机天数更长(16.4±9.4 vs 11.2±10.5；P = 0.002)。AHRF病例中，PARDS患者的全因PICU死亡率高于非PARDS患者(30.8% [95% CI, 21.5-41.3] vs. 14.4% [95% CI, 7.9-23.4]；P = 0.01)。结论：在2019-2021年PICU人群中，AHRF患病率为IMV病例的2.8%。在这些患者中，PARDS的患病率为50.3%，死亡率为30.8%，高于无PARDS的AHRF病例。
The Prevalence and Outcome of Acute Hypoxemic Respiratory Failure (PANDORA) Study in Mechanically Ventilated Children: Prospective Multicenter Epidemiology in Spain, 2019-2021.
Objectives: To describe the epidemiology and outcome of children with acute hypoxemic respiratory failure (AHRF) and/or pediatric acute respiratory distress syndrome (PARDS).
Design: Prospective, observational study in six nonconsecutive 2-month blocks form October 2019 to September 2021.
Setting: A network of 22 PICUs in Spain.
Patients: Consecutive children (7 d to 15 yr old) with a diagnosis of AHRF, defined by Pao2/Fio2 ratio less than or equal to 300 mm Hg, who needed invasive mechanical ventilation (IMV) using positive end-expiratory pressure (PEEP) greater than or equal to 5 cm H2O and Fio2 greater than or equal to 0.3.
Interventions: None.
Measurements and main results: The primary outcomes were AHRF prevalence and PICU mortality. The secondary outcomes were the prevalence of IMV with PARDS (IMV-PARDS) and the use of adjunctive therapies. There were 6545 PICU admissions: 1374 (21%) underwent IMV and 181 (2.8%) had AHRF. Ninety-one patients (1.4% of PICU admissions, 6.6% of IMV cases, and 50.3% of AHRF cases) met the Second Pediatric Acute Lung Injury Consensus Conference IMV-PARDS criteria. At baseline, mean (± sd) tidal volume was 7.4 ± 1.8 mL/kg ideal body weight, PEEP 8.4 ± 3.1 cm H2O, Fio2 0.68 ± 0.23, and plateau pressure 25.7 ± 6.3 cm H2O. Unlike patients with PARDS, adjunctive therapies were used infrequently in non-PARDS AHRF patients. AHRF patients without PARDS had more ventilator-free days than PARDS patients (16.4 ± 9.4 vs. 11.2 ± 10.5; p = 0.002). All-cause PICU mortality in AHRF cases was higher in PARDS vs. non-PARDS patients (30.8% [95% CI, 21.5-41.3] vs. (14.4% [95% CI, 7.9-23.4]; p = 0.01).
Conclusions: In our 2019-2021 PICU population, the prevalence of AHRF is 2.8% of IMV cases. Of such patients, the prevalence of PARDS was 50.3%, and there was a 30.8% mortality, which was higher than in cases of AHRF without PARDS.
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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