机械通气儿童急性低氧性呼吸衰竭（PANDORA）研究：2019 - 2021年西班牙前瞻性多中心流行病学研究
The Prevalence and Outcome of Acute Hypoxemic Respiratory Failure (PANDORA) Study in Mechanically Ventilated Children: Prospective Multicenter Epidemiology in Spain, 2019-2021.
作者信息
López-Fernández Yolanda M, Martínez-de-Azagra Amelia, Reyes-Domínguez Susana B, Gómez-Zamora Ana, Herrera-Castillo Laura, Coca-Pérez Ana, Parrilla-Parrilla Julio, Medina Alberto, García-Iñiguez Juan P, Brezmes-Raposo Marta, Hernández-Yuste Alexandra, Llorente de la Fuente Ana M, Ibarra de la Rosa Ignacio, León-González José S, Trastoy-Quintela Javier, Arjona-Villanueva David, González-Martín Jesús M, Szakmany Tamas, Villar Jesús
机构信息
Pediatric Intensive Care Unit, Department of Pediatrics, Cruces University Hospital, Biocruces-Bizkaia Health Research Institute, Bizkaia, Spain.
Pediatric Intensive Care Unit, Niño Jesús University Hospital, Madrid, Spain.
出版信息
Pediatr Crit Care Med. 2025 Jun 1;26(6):e759-e772. doi: 10.1097/PCC.0000000000003743. Epub 2025 Apr 25.
OBJECTIVES
To describe the epidemiology and outcome of children with acute hypoxemic respiratory failure (AHRF) and/or pediatric acute respiratory distress syndrome (PARDS).
DESIGN
Prospective, observational study in six nonconsecutive 2-month blocks form October 2019 to September 2021.
SETTING
A network of 22 PICUs in Spain.
PATIENTS
Consecutive children (7 d to 15 yr old) with a diagnosis of AHRF, defined by Pa o2 /F io2 ratio less than or equal to 300 mm Hg, who needed invasive mechanical ventilation (IMV) using positive end-expiratory pressure (PEEP) greater than or equal to 5 cm H 2 O and F io2 greater than or equal to 0.3.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
The primary outcomes were AHRF prevalence and PICU mortality. The secondary outcomes were the prevalence of IMV with PARDS (IMV-PARDS) and the use of adjunctive therapies. There were 6545 PICU admissions: 1374 (21%) underwent IMV and 181 (2.8%) had AHRF. Ninety-one patients (1.4% of PICU admissions, 6.6% of IMV cases, and 50.3% of AHRF cases) met the Second Pediatric Acute Lung Injury Consensus Conference IMV-PARDS criteria. At baseline, mean (± sd ) tidal volume was 7.4 ± 1.8 mL/kg ideal body weight, PEEP 8.4 ± 3.1 cm H 2 O, F io2 0.68 ± 0.23, and plateau pressure 25.7 ± 6.3 cm H 2 O. Unlike patients with PARDS, adjunctive therapies were used infrequently in non-PARDS AHRF patients. AHRF patients without PARDS had more ventilator-free days than PARDS patients (16.4 ± 9.4 vs. 11.2 ± 10.5; p = 0.002). All-cause PICU mortality in AHRF cases was higher in PARDS vs. non-PARDS patients (30.8% [95% CI, 21.5-41.3] vs. (14.4% [95% CI, 7.9-23.4]; p = 0.01).
CONCLUSIONS
In our 2019-2021 PICU population, the prevalence of AHRF is 2.8% of IMV cases. Of such patients, the prevalence of PARDS was 50.3%, and there was a 30.8% mortality, which was higher than in cases of AHRF without PARDS.
目的
描述急性低氧性呼吸衰竭（AHRF）和/或儿童急性呼吸窘迫综合征（PARDS）患儿的流行病学特征及预后。
设计
于2019年10月至2021年9月期间进行的一项前瞻性观察性研究，分六个不连续的2个月时间段进行。
地点
西班牙22个儿科重症监护病房（PICU）组成的网络。
患者
连续纳入诊断为AHRF的儿童（7天至15岁），其定义为动脉血氧分压（PaO₂）/吸入氧分数值（FiO₂）≤300 mmHg，且需要使用呼气末正压（PEEP）≥5 cmH₂O和FiO₂≥0.3进行有创机械通气（IMV）。
干预措施
无。
测量指标及主要结果
主要结局为AHRF患病率和PICU死亡率。次要结局为合并PARDS的IMV（IMV-PARDS）患病率及辅助治疗的使用情况。共有6545例患儿入住PICU：1374例（21%）接受了IMV，181例（2.8%）患有AHRF。91例患者（占PICU入院患者的1.4%、IMV病例的6.6%以及AHRF病例的50.3%）符合第二届儿童急性肺损伤共识会议的IMV-PARDS标准。基线时，平均（±标准差）潮气量为7.4±1.8 mL/kg理想体重，PEEP为8.4±3.1 cmH₂O，FiO₂为0.68±0.23，平台压为25.7±6.3 cmH₂O。与PARDS患者不同，非PARDS的AHRF患者较少使用辅助治疗。未合并PARDS的AHRF患者无呼吸机天数多于PARDS患者（16.4±9.4天 vs. 11.2±10.5天；p = 0.002）。PARDS的AHRF病例全因PICU死亡率高于非PARDS患者（30.8% [95%CI，21.5 - 41.3] vs. 14.4% [95%CI，7.9 - 23.4]；p = 0.01）。
结论
在我们2019 - 2021年的PICU人群中，AHRF患病率为IMV病例的2.8%。在这些患者中，PARDS患病率为50.3%，死亡率为30.8%，高于未合并PARDS的AHRF病例。
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