Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA.
Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA.
Pediatr Crit Care Med. 2019 Sep;20(9):e441-e446. doi: 10.1097/PCC.0000000000002008.
Infectious pneumonia is the most common cause of acute respiratory distress syndrome, with viruses frequently implicated as causative. However, the significance of viruses in pediatric acute respiratory distress syndrome is unknown. We aimed to characterize the epidemiology of viral pneumonia in pediatric acute respiratory distress syndrome and compare characteristics and outcomes between pneumonia subjects with and without viruses. Secondarily, we examined the association between specific viruses and outcomes.
We performed a secondary analysis of a prospectively enrolled pediatric acute respiratory distress syndrome cohort. Subjects with pneumonia acute respiratory distress syndrome underwent testing of respiratory secretions for viruses and culture for bacteria and fungi and were stratified according to presence or absence of a virus.
Tertiary care children's hospital.
Children with acute respiratory distress syndrome.
None.
Of 544 children with acute respiratory distress syndrome, 282 (52%) had pneumonia as their inciting etiology, of whom 212 were virus-positive. In 141 of 282 (50%) pneumonia acute respiratory distress syndrome cases, a virus was the sole pathogen identified. Virus-positive pneumonia had fewer organ failures but worse oxygenation, relative to virus-negative pneumonia, with no differences in antibiotic use, ventilator duration, or mortality. Subjects with respiratory syncytial virus-associated acute respiratory distress syndrome had lower mortality (0%), and subjects with influenza-associated acute respiratory distress syndrome had shorter ventilator duration, relative to other viral acute respiratory distress syndrome. Nonadeno herpesviruses, tested for exclusively in immunocompromised subjects, had greater than 80% mortality.
Pneumonia was the most common cause of pediatric acute respiratory distress syndrome, and viruses were commonly isolated as the sole pathogen. Respiratory syncytial virus and influenza were associated with better outcomes relative to other viral etiologies. Viral pneumonias in immunocompromised subjects, particularly nonadeno herpesviruses, drove the mortality rate for pneumonia acute respiratory distress syndrome. Specific viral etiologies are associated with differential outcomes in pediatric acute respiratory distress syndrome and should be accounted for in future studies.
感染性肺炎是急性呼吸窘迫综合征（ARDS）最常见的病因，常与病毒感染有关。然而，病毒在儿科 ARDS 中的作用尚不清楚。本研究旨在描述儿科 ARDS 患者病毒性肺炎的流行病学特征，并比较病毒性肺炎和非病毒性肺炎患者的特征和结局。其次，我们还探讨了特定病毒与结局之间的关系。
我们对一个前瞻性纳入的儿科 ARDS 队列进行了二次分析。患有肺炎性 ARDS 的患者进行呼吸道分泌物病毒检测和细菌及真菌培养，并根据是否存在病毒进行分层。
三级儿童专科医院。
患有 ARDS 的儿童。
无。
在 544 名患有 ARDS 的儿童中，282 名（52%）的发病病因是肺炎，其中 212 名患儿病毒检测阳性。在 282 例（50%）肺炎性 ARDS 患者中，141 例（50%）患者仅有一种病原体被检测到。病毒阳性肺炎的器官衰竭发生率较低，但氧合情况更差，与病毒阴性肺炎相比，抗生素使用、呼吸机使用时间或死亡率无差异。与其他病毒性 ARDS 相比，呼吸道合胞病毒相关 ARDS 患者的死亡率（0%）较低，流感相关 ARDS 患者的呼吸机使用时间较短。在免疫功能低下的患者中专门检测到的非腺病毒疱疹病毒，其死亡率超过 80%。
肺炎是儿科 ARDS 最常见的病因，病毒常作为唯一病原体被分离出来。与其他病毒病因相比，呼吸道合胞病毒和流感与更好的结局相关。免疫功能低下患者的病毒性肺炎，特别是非腺病毒疱疹病毒，导致了肺炎性 ARDS 的死亡率。特定的病毒病因与儿科 ARDS 的不同结局相关，应在未来的研究中加以考虑。
