脓毒症相关小儿急性呼吸窘迫综合征：一项多中心前瞻性队列研究。
Sepsis-related pediatric acute respiratory distress syndrome: A multicenter prospective cohort study.
作者信息
Prasertsan Pharsai, Anantasit Nattachai, Walanchapruk Suchanuch, Roekworachai Koonkoaw, Samransamruajkit Rujipat, Vaewpanich Jarin
机构信息
Department of Pediatrics, Division of Pediatric Pulmonology and Critical Care Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Department of Pediatrics, Division of Pediatric Critical Care, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
出版信息
Turk J Emerg Med. 2023 Jan 9;23(2):96-103. doi: 10.4103/tjem.tjem_237_22. eCollection 2023 Apr-Jun.
OBJECTIVES
This study aimed to compare the risk factors and outcomes for organ dysfunction between sepsis-related Pediatric acute respiratory distress syndrome (PARDS) and nonsepsis PARDS.
METHODS
We prospective cohort recruited intubated patients with PARDS at four tertiary care centers in Thailand. The baseline characteristics, mechanical ventilation, fluid balance, and clinical outcomes were collected. The primary outcome was organ dysfunction.
RESULTS
One hundred and thirty-two mechanically ventilated children with PARDS were included in the study. The median age was 29 months and 53.8% were male. The mortality rate was 22.7% and organ dysfunction was 45.4%. There were 26 (19.7%) and 106 (80.3%) patients who were classified into sepsis-related PARDS and nonsepsis PARDS, respectively. Sepsis-related PARDS patients had a significantly higher incidence of acute kidney injury (30.8% vs. 13.2%, P = 0.041), septic shock (88.5% vs. 32.1%, P < 0.001), organ dysfunction (84.6% vs. 35.8%, P < 0.001), and death (42.3% vs. 17.9%, P = 0.016) than nonsepsis PARDS group. Multivariate analysis adjusted for clinical variables showed that sepsis-related PARDS and percentage of fluid overload were significantly associated with organ dysfunction (odds ratio [OR] 11.414; 95% confidence interval [CI] 1.40892.557, P = 0.023 and OR 1.169; 95% CI 1.0121.352, P = 0.034).
CONCLUSIONS
Sepsis-related PARDS patients had more severe illness, organ dysfunction, and mortality than nonsepsis PARDS patients. The higher percentage of fluid overload and presentation of sepsis was the independent risk factor of organ dysfunction in PARDS patients.
目的
本研究旨在比较脓毒症相关儿童急性呼吸窘迫综合征（PARDS）与非脓毒症PARDS患者器官功能障碍的危险因素及预后情况。
方法
我们在泰国的四个三级医疗中心前瞻性队列招募了插管的PARDS患者。收集了基线特征、机械通气、液体平衡及临床结局。主要结局为器官功能障碍。
结果
132例接受机械通气的PARDS儿童纳入研究。中位年龄为29个月，53.8%为男性。死亡率为22.7%，器官功能障碍发生率为45.4%。分别有26例（19.7%）和106例（80.3%）患者被分类为脓毒症相关PARDS和非脓毒症PARDS。脓毒症相关PARDS患者急性肾损伤（30.8%对13.2%，P = 0.041）、感染性休克（88.5%对32.1%，P < 0.001）、器官功能障碍（84.6%对35.8%，P < 0.001）及死亡（42.3%对17.9%，P = 0.016）的发生率显著高于非脓毒症PARDS组。对临床变量进行校正的多因素分析显示，脓毒症相关PARDS及液体超负荷百分比与器官功能障碍显著相关（比值比[OR] 11.414；95%置信区间[CI] 1.408 - 9,2.557，P = 0.023及OR 1.169；95% CI 1.012 - 1.352，P = 0.034）。
结论
脓毒症相关PARDS患者比非脓毒症PARDS患者病情更严重、器官功能障碍更明显且死亡率更高。液体超负荷百分比更高及脓毒症表现是PARDS患者器官功能障碍的独立危险因素。
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