儿童肺挫伤相关小儿急性呼吸窘迫综合征（PARDS）。
Pediatric Acute Respiratory Distress Syndrome (PARDS) in Children With Pulmonary Contusion.
机构信息
Division of Pediatric Critical Care Medicine and Pediatric Cardiology, 37292Children's Hospital at Montefiore, Bronx, NY, USA.
Albert Einstein College of Medicine, Bronx, NY, USA.
出版信息
J Intensive Care Med. 2021 Jan;36(1):107-114. doi: 10.1177/0885066619887666. Epub 2019 Nov 11.
OBJECTIVE
There is paucity of data about prevalence of pediatric acute respiratory distress syndrome (PARDS) in children with pulmonary contusion (PC). We intend to evaluate PC in children with chest trauma and the association between PC and PARDS.
DESIGN
Retrospective review of Institutional Trauma Registry for patients with trauma.
SETTING
Level 1 trauma center.
PATIENTS
Age 18 years and younger with a diagnosis of PC.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Of the 1916 children with trauma, 50 (2.6%) had PC. Patients with PC and PARDS had lower Glasgow Coma Scale (GCS) score (7 [3-15] vs 15 [15-15], = .0003), higher Injury Severity Scale (ISS) score (29 [22-34] vs 19 [14-22], = .004), lower oxygen saturations (96 [93-99] days vs 99 [98-100] days, = .0009), higher FiO (1 [1-1] vs 0.21 [0.21-0.40], < .0001), lower oxygen saturation/FiO (S/F) ratios (97 [90-99] vs 457 [280-471], < .0001), need for invasive mechanical ventilation (IMV; 86% vs 23%, < .0001), and mortality (28% vs 0%, = .006) compared to those without PARDS. Forty-two percent (21/50) of patients needed IMV, of these 61% (13/21) had PARDS. Patients who needed IMV had significantly lower GCS score (8 [3-11] vs 15 [15-15], < .0001), higher ISS score (27 [22-34] vs 18 [14-22], = .002), longer length of stay (LOS; 7.5 [4-14] days vs 3.3 [2-5] days, = .003), longer hospital LOS (18 [7.0-25] vs 5 [4-11], = .008), higher PARDS rate (62% vs 7%, < .0001), and lower S/F ratios (99 [94-190] vs 461 [353-471], < .0001) compared to those who did not require IMV. Lower GCS score was independently associated with both PARDS and need for IMV.
CONCLUSIONS
Pediatric ARDS in children with PC is independently associated with lower GCS score, and its presence significantly increased morbidity and mortality. Further larger studies are needed to explore association of lower GCS and higher injury score in children with PARDS and PC.
目的
有关小儿肺挫伤（PC）患儿中儿科急性呼吸窘迫综合征（PARDS）的患病率的数据很少。我们旨在评估胸部创伤患儿中的 PC 并研究 PC 与 PARDS 之间的关系。
设计
对机构创伤登记处中创伤患者进行回顾性分析。
地点
一级创伤中心。
患者
年龄在 18 岁以下并伴有 PC 诊断的患者。
干预措施
无。
测量和主要结果
在 1916 名患有创伤的儿童中，有 50 名（2.6%）患有 PC。患有 PC 和 PARDS 的患者格拉斯哥昏迷评分（GCS）较低（7[3-15] 与 15[15-15]， =.0003），损伤严重程度评分（ISS）较高（29[22-34] 与 19[14-22]， =.004），氧饱和度较低（96[93-99]天与 99[98-100]天， =.0009），FiO 较高（1[1-1] 与 0.21[0.21-0.40]， <.0001），氧饱和度/FiO 比值较低（97[90-99] 与 457[280-471]， <.0001），需要有创机械通气（IMV；86%与 23%， <.0001）和死亡率（28%与 0%， =.006）。42%（50/120）的患者需要 IMV，其中 61%（13/21）患有 PARDS。需要 IMV 的患者的 GCS 评分明显较低（8[3-11] 与 15[15-15]， <.0001），ISS 评分较高（27[22-34] 与 18[14-22]， =.002），住院时间较长（7.5[4-14] 天与 3.3[2-5] 天， =.003），医院住院时间较长（18[7.0-25] 天与 5[4-11] 天， =.008），PARDS 发生率较高（62%与 7%， <.0001），氧饱和度/FiO 比值较低（99[94-190] 与 461[353-471]， <.0001）。与不需要 IMV 的患者相比，这些患者的 GCS 评分较低。较低的 GCS 评分与 PARDS 和需要 IMV 均独立相关。
结论
小儿 PC 中发生的儿科 ARDS 与较低的 GCS 评分独立相关，其存在显著增加了发病率和死亡率。需要进一步进行更大规模的研究以探讨较低的 GCS 和较高的损伤评分与患有 PARDS 和 PC 的儿童之间的关联。
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