Bustos-Gajardo Fernando D, Jeria Rodrigo Adasme, Piraino Thomas, Cruces Pablo, Damiani L Felipe
Pediatric Intensive Care unit, Hospital Dr. Víctor Ríos Ruíz, Los Ángeles, Chile.
Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile.
Pediatr Pulmonol. 2025 May;60(5):e71146. doi: 10.1002/ppul.71146.
To evaluate the ability of the criteria "At-risk for PARDS" to identify patients with acute respiratory infection hospitalized outside the pediatric intensive care unit (PICU) who are at high risk of developing pediatric acute respiratory distress syndrome (PARDS) and describe the timing for the identification. The secondary aim was to explore clinical outcome differences between patients with and without risk for PARDS.
We conducted an observational prospective cohort study from June to August 2019. Children under 15 years old hospitalized in a pediatric ward due to an acute respiratory tract infection were included.
A total of 177 patients with a median age of 12 (IQR 5; 25) months were included. Registered data included demographics, respiratory support, at-risk for PARDS and PARDS diagnosis according to PALICC consensus. PICU admission, hospital length of stay (LOS) and intrahospital mortality were the outcomes compared between children with and without risk for PARDS. The at-risk criteria, within 48 h of admission, showed an overall accuracy, sensitivity, and specificity of 82.5%, 100%, and 81.9% respectively, to detect patients that progress to PARDS. The at-risk for PARDS criteria was met in 37 cases (20.9%), which also were more likely to developed PARDS (6/37 [16.2%] vs. 0/140 [0%]; p < 0.001), had higher admission to PICU (16/37 [43.2%] vs. 0 [0%]; p < 0.001) and hospital LOS (7 [6; 12] days vs. 5 [3-6] days; p < 0.001), compared with the group without at-risk for PARDS.
The at-risk for PARDS criteria within 48 h of admission demonstrated an adequate ability to identify patients with a respiratory infection at increased risk of developing PARDS. Patients who met the at-risk for PARDS criteria before PICU admission presented with unfavorable clinical outcomes compared with those without risk.
评估“儿童急性呼吸窘迫综合征（PARDS）风险”标准识别在儿科重症监护病房（PICU）以外住院的急性呼吸道感染患儿发生PARDS高风险的能力，并描述识别时机。次要目的是探讨有PARDS风险和无PARDS风险患者的临床结局差异。
我们于2019年6月至8月进行了一项观察性前瞻性队列研究。纳入因急性呼吸道感染在儿科病房住院的15岁以下儿童。
共纳入177例患者，中位年龄为12（四分位间距5；25）个月。记录的数据包括人口统计学、呼吸支持、PARDS风险以及根据儿科急性呼吸窘迫综合征全球共识（PALICC）诊断的PARDS。比较有PARDS风险和无PARDS风险儿童的PICU入院情况、住院时间（LOS）和院内死亡率。入院48小时内的风险标准对进展为PARDS的患者检测的总体准确率、敏感性和特异性分别为82.5%、100%和81.9%。37例（20.9%）符合PARDS风险标准，这些患者发生PARDS的可能性也更高（6/37 [16.2%] 对比 0/140 [0%]；p < 0.001），与无PARDS风险组相比，PICU入院率更高（16/37 [43.2%] 对比 0 [零]；p < 0.001），住院LOS更长（7 [6；12]天对比5 [3 - 6]天；p < 0.001）。
入院48小时内的PARDS风险标准显示出有足够能力识别发生PARDS风险增加的呼吸道感染患者。与无风险患者相比，在PICU入院前符合PARDS风险标准的患者临床结局不佳。
