儿科急性呼吸窘迫综合征的风险分层：一项多中心观察性研究。
Risk Stratification in Pediatric Acute Respiratory Distress Syndrome: A Multicenter Observational Study.
机构信息
1Children's Intensive Care Unit, Department of Pediatric Subspecialities, KK Women's and Children's Hospital, Singapore. 2Duke-NUS Medical School, Singapore. 3Pediatric Intensive Care Unit, National Children's Hospital, Hanoi, Vietnam. 4Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 5Pediatric Intensive Care Unit, Department of Pediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore. 6Department of Pediatrics, Sarawak General Hospital, Kuching, Malaysia. 7Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, Beijing, China. 8Division of Pediatric Critical Care, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 9Pediatric Department, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 10Department of Pediatrics, University Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia. 11Children's Hospital of Chongqing Medical University, Chongqing, China. 12Center for Quantitative Medicine, Duke-NUS Medical School, Singapore.
出版信息
Crit Care Med. 2017 Nov;45(11):1820-1828. doi: 10.1097/CCM.0000000000002623.
OBJECTIVES
The Pediatric Acute Lung Injury Consensus Conference developed a pediatric specific definition 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 definition of PARDS is a useful tool for risk stratification.
目的
儿科急性肺损伤共识会议制定了急性呼吸窘迫综合征（PARDS）的儿科专用定义。在此定义中，肺部疾病的严重程度分为轻度、中度和重度。我们旨在描述亚洲 PARDS 患者的流行病学，并评估儿科急性肺损伤共识会议风险分层是否准确预测 PARDS 的结局。
设计
多中心、回顾性、描述性队列研究。
地点
亚洲的 10 个多学科 PICUs。
患者
2009 年至 2015 年间符合儿科急性肺损伤共识会议 PARDS 标准的所有机械通气儿童。
干预措施
无。
测量和主要结果
收集了有关流行病学、通气、辅助治疗和临床结局的数据。患者在诊断为 PARDS 后 100 天进行随访。共纳入 373 例患者。轻度、中度和重度 PARDS 患者分别为 89 例（23.9%）、149 例（39.9%）和 135 例（36.2%）。PARDS 的最常见危险因素是肺炎/下呼吸道感染（309 [82.8%]）。PARDS 严重程度越高，无呼吸机天数（22 [17-25]、16 [0-23]、6 [0-19]；轻度、中度和重度分别 p<0.001）和 PICUF 无天数（19 [11-24]、15 [0-22]、5 [0-20]；轻度、中度和重度分别 p<0.001）越低。PARDS 的总体 PICUF 死亡率为 373 例中的 113 例（30.3%），100 天死亡率为 317 例中的 126 例（39.7%）。在多变量 Cox 比例风险回归模型中，校正地点、合并症存在和疾病严重程度后，中度（风险比，1.88 [95%CI，1.03-3.45]；p=0.039）和重度 PARDS（风险比，3.18 [95%CI，1.68，6.02]；p<0.001）患者的死亡率高于轻度 PARDS 患者。
结论
亚洲 PARDS 的死亡率很高。儿科急性肺损伤共识会议制定的 PARDS 定义是一种有用的风险分层工具。
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