Vargas-Acevedo Catalina, Botero Marín Mónica, Jaime Trujillo Catalina, Hernández Laura Jimena, Vanegas Melisa Naranjo, Moreno Sergio Mauricio, Rueda-Guevara Paola, Baquero Olga, Bonilla Carolina, Mesa María L, Restrepo Sonia, Barrera Pedro, Mejía Luz M, Piñeros Juan G, Ramírez Varela Andrea
Pediatrics Residency Program Universidad de los Andes Bogotá Colombia.
Department of Pediatrics Hospital Universitario Fundación Santa Fe de Bogotá Bogotá Colombia.
Health Sci Rep. 2024 Jun 12;7(6):e1994. doi: 10.1002/hsr2.1994. eCollection 2024 Jun.
Acute respiratory failure (ARF) is the most frequent cause of cardiorespiratory arrest and subsequent death in children worldwide. There have been limited studies regarding ARF in high altitude settings. The aim of this study was to calculate mortality and describe associated factors for severity and mortality in children with ARF.
The study was conducted within a prospective multicentric cohort that evaluated the natural history of pediatric ARF. For this analysis three primary outcomes were studied: mortality, invasive mechanical ventilation, and pediatric intensive care unit (PICU) length of stay. Eligible patients were children older than 1 month and younger than 18 years of age with respiratory difficulty at the time of admission. Patients who developed ARF were followed at the time of ARF, 48 h later, at the time of discharge, and at 30 and 60 days after discharge. It was conducted in the pediatric emergency, in-hospital, and critical-care services in three hospitals in Bogotá, Colombia, from April 2020 to June 2021.
Out of a total of 685 eligible patients, 296 developed ARF for a calculated incidence of ARF of 43.2%. Of the ARF group, 90 patients (30.4%) needed orotracheal intubation, for a mean of 9.57 days of ventilation (interquartile range = 3.00-11.5). Incidence of mortality was 6.1% ( = 18). The associated factors for mortality in ARF were a history of a neurologic comorbidity and a higher fraction of inspired oxygen at ARF diagnosis. For PICU length of stay, the associated factors were age between 2 and 5 years of age, exposure to smokers, and respiratory comorbidity. Finally, for mechanical ventilation, the risk factors were obesity and being unstable at admission.
ARF is a common cause of morbidity and mortality in children. Understanding the factors associated with greater mortality and severity of ARF might allow earlier recognition and initiation of prompt treatment strategies.
急性呼吸衰竭（ARF）是全球儿童心肺骤停及随后死亡的最常见原因。关于高海拔地区ARF的研究有限。本研究的目的是计算死亡率，并描述ARF患儿严重程度及死亡率的相关因素。
本研究在一项前瞻性多中心队列研究中进行，该研究评估了小儿ARF的自然病程。对于本分析，研究了三个主要结局：死亡率、有创机械通气和儿科重症监护病房（PICU）住院时间。符合条件的患者为入院时出现呼吸困难、年龄大于1个月且小于18岁的儿童。发生ARF的患者在ARF发生时、48小时后、出院时以及出院后30天和60天进行随访。该研究于2020年4月至2021年6月在哥伦比亚波哥大的三家医院的儿科急诊、住院和重症监护服务部门进行。
在总共685名符合条件的患者中，296人发生了ARF，计算得出的ARF发病率为43.2%。在ARF组中，90名患者（30.4%）需要经口气管插管，平均通气时间为9.57天（四分位间距=3.00-11.5）。死亡率为6.1%（n=18）。ARF死亡率的相关因素是神经系统合并症病史以及ARF诊断时较高的吸入氧分数。对于PICU住院时间，相关因素是2至5岁的年龄、接触吸烟者以及呼吸系统合并症。最后，对于机械通气，危险因素是肥胖和入院时不稳定。
ARF是儿童发病和死亡的常见原因。了解与ARF更高死亡率和严重程度相关的因素可能有助于早期识别并启动及时的治疗策略。
