2019冠状病毒病感染儿童急性呼吸窘迫综合征的临床表现、治疗及预后的回顾性分析
A Retrospective Analysis of Clinical Manifestations, Management and Outcome of Acute Respiratory Distress Syndrome Associated with Coronavirus Disease-2019 Infection in Children.
作者信息
Sarkar Mihir, Das Bratesh, Mahapatra Manas K, Roychowdhoury Satyabrata, Das Sambhunath, Konar Mithun C
机构信息
Department of Pediatrics, Medical College, Kolkata, West Bengal, India.
出版信息
Indian J Crit Care Med. 2022 Mar;26(3):331-338. doi: 10.5005/jp-journals-10071-24145.
BACKGROUND
Acute respiratory distress syndrome (ARDS) associated with COVID-19 in children is not well described in the literature, so this study was designed to assess the severity, clinical course, different treatment measures, and outcome of this group of patients.
PATIENTS AND METHODS
This descriptive study was performed by retrospective chart review of children admitted in pediatric intensive care unit (PICU) in the age-group of 1 month to 12 years over the period of 6 months (July-December 2020) in a tertiary care pediatric COVID facility in eastern India. Severity of ARDS, ventilator settings, oxygenation and laboratory parameters, and outcomes were documented. Predictors associated with severe ARDS were evaluated.
RESULTS
Among 128 laboratory-confirmed pediatric COVID-19 cases admitted in PICU, 18 (14%) developed ARDS, 6 (33.3%) had severe ARDS, and 3 (16.6%) succumbed to death. Outcome was measured by median hospital stay [20 days (IQR 19, 21)], PICU stay [13 days (IQR 10, 16)], and 28-day ventilator-free days [14 days (IQR 13, 22)]. Half ( = 9) of our study cohort had different comorbidities and congenital heart disease being the most common (4, 22.2%). Median positive end-expiratory pressure requirement was 10 cm HO (9, 11) for invasively ventilated children ( = 13, 72.2%) along with peak inspiratory pressure of 24 cm HO (20, 29) and mean airway pressure of 17 cm HO (14, 20). Median oxygenation index was 13.3 (10.5, 18.6). Nine (69.2%) out of 13 intubated children had undergone prone ventilation. C-reactive protein (CRP) and D-dimer levels were significantly high in children with severe ARDS alongside pSOFA and lung USG score.
CONCLUSION
Incidence of ARDS in pediatric COVID-19 though less but is not rare. Elevated CRP, D-dimer values, and high lung USG scores were associated with severe ARDS. Those who died had significant comorbidity.
HOW TO CITE THIS ARTICLE
Sarkar M, Das B, Mahapatra MK, Roychowdhoury S, Das S, Konar MC. A Retrospective Analysis of Clinical Manifestations, Management and Outcome of Acute Respiratory Distress Syndrome Associated with Coronavirus Disease-2019 Infection in Children. Indian J Crit Care Med 2022;26(3):331-338.
背景
儿童新型冠状病毒肺炎（COVID-19）相关的急性呼吸窘迫综合征（ARDS）在文献中描述较少，因此本研究旨在评估该组患者的严重程度、临床病程、不同治疗措施及预后。
患者与方法
本描述性研究通过回顾性查阅印度东部一家三级儿科COVID医疗机构在2020年7月至12月6个月期间收入儿科重症监护病房（PICU）的1个月至12岁儿童的病历进行。记录ARDS的严重程度、呼吸机设置、氧合及实验室参数和预后。评估与重度ARDS相关的预测因素。
结果
在PICU收治的128例实验室确诊的儿童COVID-19病例中，18例（14%）发生ARDS，6例（33.3%）为重度ARDS，3例（16.6%）死亡。预后指标为中位住院时间[20天（IQR 19，21）]、PICU住院时间[13天（IQR 10，16）]和28天无呼吸机天数[14天（IQR 13，22）]。我们研究队列中有一半（n = 9）有不同合并症，先天性心脏病最为常见（4例，22.2%）。有创通气儿童（n = 13，72.2%）的呼气末正压中位需求为10 cmH₂O（9，11），吸气峰压为24 cmH₂O（20，29），平均气道压为17 cmH₂O（14，20）。中位氧合指数为13.3（10.5，18.6）。13例插管儿童中有9例（69.2%）接受了俯卧位通气。重度ARDS儿童的C反应蛋白（CRP）和D-二聚体水平显著升高，同时伴有序贯器官衰竭评估（pSOFA）和肺部超声评分升高。
结论
儿童COVID-19中ARDS的发生率虽低但并不罕见。CRP、D-二聚体值升高及肺部超声评分高与重度ARDS相关。死亡患者有明显合并症。
如何引用本文
Sarkar M, Das B, Mahapatra MK, Roychowdhoury S, Das S, Konar MC. A Retrospective Analysis of Clinical Manifestations, Management and Outcome of Acute Respiratory Distress Syndrome Associated with Coronavirus Disease-2019 Infection in Children. Indian J Crit Care Med 2022;26(3):331-338.
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