Hamill Grant S, Remy Kenneth E, Slain Katherine N, Sallee Colin J, Khemani Robinder, Smith Lincoln, Shein Steven L
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, CA.
Pediatr Crit Care Med. 2023 Jul 1;24(7):574-583. doi: 10.1097/PCC.0000000000003217. Epub 2023 Feb 21.
Describe the frequency with which transfusion and medications that modulate lung injury are administered to children meeting at-risk for pediatric acute respiratory distress syndrome (ARF-PARDS) criteria and evaluate for associations of transfusion, fluid balance, nutrition, and medications with unfavorable clinical outcomes.
Secondary analysis of the Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study, a prospective point prevalence study. All enrolled ARF-PARDS patients were included unless they developed subsequent pediatric acute respiratory distress syndrome (PARDS) within 24 hours of PICU admission or PICU length of stay was less than 24 hours. Univariate and multivariable analyses were used to identify associations between therapies given during the first 2 calendar days after ARF-PARDS diagnosis and subsequent PARDS diagnosis (primary outcome), 28-day PICU-free days (PFDs), and 28-day ventilator-free days (VFDs).
Thirty-seven international PICUs.
Two hundred sixty-seven children meeting Pediatric Acute Lung Injury Consensus Conference ARF-PARDS criteria.
None.
During the first 2 days after meeting ARF-PARDS criteria, 55% of subjects received beta-agonists, 42% received corticosteroids, 28% received diuretics, and 9% were transfused. Subsequent PARDS (15%) was associated with platelet transfusion (n = 11; adjusted odds ratio: 4.75 [95% CI 1.03-21.92]) and diuretics (n = 74; 2.55 [1.19-5.46]) in multivariable analyses that adjusted for comorbidities, PARDS risk factor, initial oxygen saturation by pulse oximetry:Fio2 ratio, and initial type of ventilation. Beta-agonists were associated with lower adjusted odds of subsequent PARDS (0.43 [0.19-0.98]). Platelets and diuretics were also associated with fewer PFDs and fewer VFDs in the multivariable models, and TPN was associated with fewer PFDs. Corticosteroids, net fluid balance, and volume of enteral feeding were not associated with the primary or secondary outcomes.
There is an independent association between platelet transfusion, diuretic administration, and unfavorable outcomes in children at risk for PARDS, although this may be related to treatment bias and unmeasured confounders. Nevertheless, prospective evaluation of the role of these management strategies on outcomes in children with ARF-PARDS is needed.
描述对符合小儿急性呼吸窘迫综合征（ARF-PARDS）标准的高危儿童进行输血和使用调节肺损伤药物的频率，并评估输血、液体平衡、营养和药物与不良临床结局之间的关联。
对小儿急性呼吸窘迫综合征发病率和流行病学研究进行二次分析，这是一项前瞻性点患病率研究。所有纳入的ARF-PARDS患者均被纳入，除非他们在PICU入院后24小时内发生后续小儿急性呼吸窘迫综合征（PARDS）或PICU住院时间少于24小时。采用单变量和多变量分析来确定ARF-PARDS诊断后最初2个日历日内给予的治疗与后续PARDS诊断（主要结局）、28天无PICU天数（PFD）和28天无呼吸机天数（VFD）之间的关联。
37个国际PICU。
267名符合小儿急性肺损伤共识会议ARF-PARDS标准的儿童。
无。
在符合ARF-PARDS标准后的头2天内，55%的受试者接受了β受体激动剂，42%接受了皮质类固醇，28%接受了利尿剂，9%接受了输血。在对合并症、PARDS危险因素、经脉搏血氧饱和度测定的初始氧饱和度:Fio2比值和初始通气类型进行校正的多变量分析中，后续PARDS（15%）与血小板输血（n = 11；校正比值比：4.75 [95% CI 1.03 - 21.92]）和利尿剂（n = 74；2.55 [1.19 - 5.46]）相关。β受体激动剂与后续PARDS的校正低比值相关（0.43 [0.19 - 0.98]）。在多变量模型中，血小板和利尿剂也与较少的PFD和较少的VFD相关，全胃肠外营养（TPN）与较少的PFD相关。皮质类固醇、净液体平衡和肠内喂养量与主要或次要结局无关。
在PARDS高危儿童中血小板输血、利尿剂使用与不良结局之间存在独立关联，尽管这可能与治疗偏倚和未测量的混杂因素有关。然而，仍需要对这些管理策略在ARF-PARDS儿童结局中的作用进行前瞻性评估。
