White Benjamin R, Polikoff Lee, Alexander Robin, Baer Benjamin R, Rotta Alexandre T, González-Dambrauskas Sebastián, Izquierdo Ledys M, Castellani Pablo, Watson Christopher M, Nofziger Ryan A, Pon Steven, Karsies Todd, Shein Steven L
Department of Pediatrics, Division of Pediatric Critical Care, University of Utah, Salt Lake City, UT.
Department of Pediatrics, Division of Critical Care Medicine, The Warren Alpert Medical School of Brown University, Providence, RI.
Pediatr Crit Care Med. 2025 May 1;26(5):e600-e610. doi: 10.1097/PCC.0000000000003712. Epub 2025 Mar 6.
Bronchiolitis and other lower respiratory tract infections (LRTIs) are the most common causes of pediatric respiratory failure. There is insufficient evidence characterizing pediatric acute respiratory distress syndrome (PARDS) in young children with LRTI to inform clinical management. We aimed to describe the prevalence and clinical characteristics of children intubated for LRTI and meeting PARDS criteria.
We performed a post hoc analysis of data from the Bronchiolitis And COdetectioN (BACON) study, an international prospective observational study of critical bronchiolitis. We compared PARDS subjects (meeting criteria the first full calendar day following intubation) to non-PARDS subjects.
Forty-eight international PICUs recruiting to the BACON study, from December 2019 to November 2020.
Children younger than 2 years old, requiring mechanical ventilation for acute LRTI.
None.
Complete data were available for 571 children. Day 1 PARDS was diagnosed in 240 subjects(42%) and associated with increased mortality (7.9% vs. 2.7%; p = 0.023), greater duration of invasive ventilation (165 hr [interquartile range, 112-251 hr] vs. 135 hr [76-204 hr]; p < 0.001), and PICU length of stay (11 d [7-16 d] vs. 8 d [5-13 d]; p < 0.001). In our multivariable competing risk model, the presence of PARDS on day 1 was causally related to a prolonged duration of mechanical ventilation with the probability of extubation at 7 days for those with PARDS equal to 49% (44-54%) compared with 64% (59-69%) for those without PARDS.
PARDS development was common in this critical bronchiolitis cohort, resulted in a longer duration of mechanical ventilation, and was associated with increased mortality and PICU length of stay. Prospective studies are needed to elucidate the optimal management of critical bronchiolitis.
细支气管炎和其他下呼吸道感染（LRTIs）是小儿呼吸衰竭最常见的病因。目前尚无足够证据描述患有LRTI的幼儿的小儿急性呼吸窘迫综合征（PARDS），以指导临床管理。我们旨在描述因LRTI插管且符合PARDS标准的儿童的患病率和临床特征。
我们对细支气管炎与共同检测（BACON）研究的数据进行了事后分析，该研究是一项关于重症细支气管炎的国际前瞻性观察性研究。我们将PARDS受试者（插管后第一个完整日历日符合标准）与非PARDS受试者进行了比较。
2019年12月至2020年11月，48个参与BACON研究的国际重症监护病房。
2岁以下因急性LRTI需要机械通气的儿童。
无。
571名儿童有完整数据。240名受试者（42%）在第1天被诊断为PARDS，且与死亡率增加相关（7.9%对2.7%；p = 0.023），有创通气时间更长（165小时[四分位间距，112 - 251小时]对135小时[76 - 204小时]；p < 0.001），以及儿科重症监护病房住院时间更长（11天[7 - 16天]对8天[5 - 13天]；p < 0.001）。在我们的多变量竞争风险模型中，第1天出现PARDS与机械通气时间延长存在因果关系，PARDS患者7天脱机概率为49%（44 - 54%），而无PARDS患者为64%（59 - 69%）。
在这个重症细支气管炎队列中，PARDS的发生很常见，导致机械通气时间延长，并与死亡率增加和儿科重症监护病房住院时间延长相关。需要进行前瞻性研究以阐明重症细支气管炎的最佳管理方法。
