Kim Soo Yeon, Kim Byuhree, Choi Sun Ha, Kim Jong Deok, Sol In Suk, Kim Min Jung, Kim Yoon Hee, Kim Kyung Won, Sohn Myung Hyun, Kim Kyu-Earn
Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea.
Acute Crit Care. 2018 Nov;33(4):222-229. doi: 10.4266/acc.2018.00136. Epub 2018 Nov 29.
The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is a pragmatic decision based on the degree of hypoxia at the time of onset. We aimed to determine whether reclassification using oxygenation metrics 24 hours after diagnosis could provide prognostic ability for outcomes in PARDS.
Two hundred and eighty-eight pediatric patients admitted between January 1, 2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectively analyzed. Reclassification based on data measured 24 hours after diagnosis was compared with the initial classification, and changes in pressure parameters and oxygenation were investigated for their prognostic value with respect to mortality.
PARDS severity varied widely in the first 24 hours; 52.4% of patients showed an improvement, 35.4% showed no change, and 12.2% either showed progression of PARDS or died. Multivariate analysis revealed that mortality risk significantly increased for the severe group, based on classification using metrics collected 24 hours after diagnosis (adjusted odds ratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes in pressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation (arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showed statistically better discriminative power for mortality (area under the receiver operating characteristic curve, 0.701; 95% CI, 0.636 to 0.766; P<0.001).
Implementation of reclassification based on oxygenation metrics 24 hours after diagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours was significantly associated with outcomes in PARDS, and oxygenation response was the most discernable surrogate metric for mortality.
儿童急性呼吸窘迫综合征（PARDS）的诊断是基于发病时缺氧程度的一种实际决策。我们旨在确定诊断后24小时使用氧合指标进行重新分类是否可为PARDS的预后提供预测能力。
对2010年1月1日至2017年1月30日期间收治的288例符合PARDS纳入标准的儿科患者进行回顾性分析。将基于诊断后24小时测量数据的重新分类与初始分类进行比较，并研究压力参数和氧合变化对死亡率的预后价值。
PARDS严重程度在最初24小时内差异很大；52.4%的患者病情改善，35.4%无变化，12.2%的患者PARDS进展或死亡。多变量分析显示，基于诊断后24小时收集的指标进行分类，严重组的死亡风险显著增加（调整优势比，26.84；95%置信区间[CI]，3.43至209.89；P=0.002）。与压力变量（吸气峰压和驱动压）的变化相比，最初24小时内氧合变化（动脉血氧分压与吸入氧分数之比）对死亡率具有统计学上更好的判别能力（受试者操作特征曲线下面积，0.701；95%CI，0.636至0.766；P<0.001）。
基于诊断后24小时氧合指标进行重新分类有效地对PARDS的预后进行了分层。最初24小时内的病情进展与PARDS的预后显著相关，氧合反应是死亡率最明显的替代指标。
