儿科重症监护病房中急性呼吸窘迫综合征的流行病学：单中心经验
Epidemiology of Acute Respiratory Distress Syndrome in Pediatric Intensive Care Unit: Single-center Experience.
作者信息
Pujari Chandrakant G, Lalitha A V, Raj John Michael, Kavilapurapu Ananya
机构信息
Department of Paediatric Intensive Care Unit, St John's Medical College and Hospital, Bengaluru, Karnataka, India.
Department of Biostatistics, St John's Medical College and Hospital, Bengaluru, Karnataka, India.
出版信息
Indian J Crit Care Med. 2022 Aug;26(8):949-955. doi: 10.5005/jp-journals-10071-24285.
BACKGROUND
Acute respiratory distress syndrome (ARDS) is characterized by dysregulated inflammation resulting in hypoxemia and respiratory failure and causes both morbidity and mortality.
OBJECTIVES
To describe the clinical profile, outcome, and predictors of mortality in ARDS in children admitted to the Pediatric intensive care unit.
MATERIALS AND METHODS
This is a single-center retrospective study conducted at a tertiary referral hospital in a 12-bed PICU involving children (1 month to 18 years) with ARDS as defined by Pediatric Acute Lung Injury Consensus Conference (PALICC) guidelines, over a period of 5 years (2016-2020). Demographic, clinical, and laboratory details at onset and during PICU stay were collected. Predictors of mortality were compared between survivors and non-survivors.
RESULTS
We identified 89 patients with ARDS. The median age at presentation was 76 months (12-124 months). The most common precipitating factor was pneumonia (66%). The majority of children (35.9%) had moderate ARDS. Overall mortality was 33% with more than half belonging to severe ARDS group (58%). On Kaplan-Meier survival curve analysis, the mean time to death was shorter in the severe ARDS group as compared to other groups. Multiorgan dysfunction was present in 46 (51.6%) of the cases. Non-survivors had higher mean pediatric logistic organ dysfunction (PELOD2) on day 1. PRISM III at admission, worsening trends of ventilator and oxygenation parameters (OI, P/F, MAP, and PEEP) independently predicted mortality after multivariate analysis.
CONCLUSION
High PRISM score predicts poor outcome, and worsening trends of ventilator and oxygenation parameters (OI, P/F, MAP, and PEEP) are associated with mortality.
HOW TO CITE THIS ARTICLE
Pujari CG, Lalitha AV, Raj JM, Kavilapurapu A. Epidemiology of Acute Respiratory Distress Syndrome in Pediatric Intensive Care Unit: Single-center Experience. Indian J Crit Care Med 2022;26(8):949-955.
背景
急性呼吸窘迫综合征（ARDS）的特征是炎症调节失调，导致低氧血症和呼吸衰竭，可引起发病和死亡。
目的
描述入住儿科重症监护病房的儿童ARDS的临床特征、结局及死亡预测因素。
材料与方法
这是一项在一家三级转诊医院的12张床位的儿科重症监护病房进行的单中心回顾性研究，研究对象为符合儿童急性肺损伤共识会议（PALICC）指南定义的ARDS患儿（1个月至18岁），研究时间为5年（2016 - 2020年）。收集了发病时及在儿科重症监护病房住院期间的人口统计学、临床和实验室详细信息。比较了幸存者和非幸存者的死亡预测因素。
结果
我们确定了89例ARDS患者。就诊时的中位年龄为76个月（12 - 124个月）。最常见的诱发因素是肺炎（66%）。大多数儿童（35.9%）患有中度ARDS。总体死亡率为33%，其中一半以上属于重度ARDS组（58%）。在Kaplan - Meier生存曲线分析中，重度ARDS组的平均死亡时间比其他组短。46例（51.6%）病例存在多器官功能障碍。非幸存者在第1天的平均儿科逻辑器官功能障碍（PELOD2）更高。多因素分析后，入院时的PRISM III评分、呼吸机和氧合参数（OI、P/F、MAP和PEEP）的恶化趋势独立预测死亡率。
结论
高PRISM评分预示预后不良，呼吸机和氧合参数（OI、P/F、MAP和PEEP）的恶化趋势与死亡率相关。
如何引用本文
Pujari CG, Lalitha AV, Raj JM, Kavilapurapu A. 儿科重症监护病房急性呼吸窘迫综合征的流行病学：单中心经验。《印度重症监护医学杂志》2022；26(8):949 - 955。
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