scholarly journals High Burden of Acquired Morbidity in Survivors of Pediatric Acute Respiratory Distress Syndrome

2021 ◽  
Author(s):  
Sin Wee Loh ◽  
Ming Ying Gan ◽  
Judith Ju-Ming Wong ◽  
Chengsi Ong ◽  
Yee Hui Mok ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Hospital Discharge ◽  
Functional Outcomes ◽  
Distress Syndrome ◽  
Severity Of Illness ◽  
Bivariate Analysis ◽  
Clinical Records

Introduction: With improving mortality rates in pediatric acute respiratory distress syndrome (PARDS), functional outcomes in survivors are increasingly important. We aim to describe the change in functional status score (FSS) from baseline to discharge and to identify risk factors associated with poor functional outcomes. Methods: We examined clinical records of patients with PARDS admitted to our pediatric intensive care unit (PICU) from 2009 to 2016. Our primary outcome was acquired morbidity at PICU and hospital discharge (defined by an increase in FSS ≥3 points above baseline). We included severity of illness scores and severity of PARDS in our bivariate analysis for risk factors for acquired morbidity. Results: There were 181 patients with PARDS, of which 90 (49.7%) survived. Median pediatric index of mortality 2 score was 4.05 (1.22, 8.70) and 21 (26.6%) patients had severe PARDS. 59 (65.6%) and 14 (15.6%) patients had acquired morbidity at PICU and hospital discharge, respectively. Median baseline FSS was 6.00 (6.00, 6.25), which increased to 11.00 (8.75, 12.00) at PICU discharge before decreasing to 7.50 (6.00, 9.25) at hospital discharge. All patients had significantly higher median FSS score at both PICU and hospital discharge compared to baseline. Feeding and respiratory were the most affected domains. After adjusting for severity of illness, severity categories of PARDS was not a risk factor for acquired morbidity. Conclusion: Acquired morbidity in respiratory and feeding domains was common in PARDS survivors. Specific attention should be given to these two domains of functional outcomes in these children.

Prognostic factors for development of acute respiratory distress syndrome following traumatic injury – a systematic review and meta-analysis

2021 ◽  
pp. 2100857
Author(s):  
Alexandre Tran ◽  
Shannon M. Fernando ◽  
Laurent J. Brochard ◽  
Eddy Fan ◽  
Kenji Inaba ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Respiratory Distress Syndrome ◽  
Prognostic Factors ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Traumatic Injury ◽  
Clinical Risk Factors ◽  
Factors Associated ◽  
Post Traumatic

PurposeTo summarise the prognostic associations between various clinical risk factors and the development of the acute respiratory distress syndrome (ARDS) following traumatic injury.MethodsWe conducted this review in accordance with the PRISMA and CHARMS guidelines. We searched six databases from inception through December 2020. We included English language studies describing the clinical risk factors associated with the development of post-traumatic ARDS, as defined by either the American-European Consensus Conference or the Berlin definition. We pooled adjusted odds ratios for prognostic factors using the random effects method. We assessed risk of bias using the QUIPS tool and certainty of findings using GRADE methodology.ResultsWe included 39 studies involving 5 350 927 patients. We identified the amount of crystalloid resuscitation as a potentially modifiable prognostic factor associated with the development of post-traumatic ARDS (adjusted odds ratio [aOR] 1.19 for each additional liter of crystalloid administered within first 6 h after injury, 95% CI 1.15 to 1.24, high certainty). Non-modifiable prognostic factors with a moderate or high certainty of association with post-traumatic ARDS included increasing age, non-Hispanic white race, blunt mechanism of injury, presence of head injury, pulmonary contusion, or rib fracture; and increasing chest injury severity.ConclusionWe identified one important modifiable factor, the amount of crystalloid resuscitation within the first 24 h of injury, and several non-modifiable factors associated with development of post-traumatic ARDS. This information should support the judicious use of crystalloid resuscitation in trauma patients and may inform the development of a risk-stratification tools.

Acute respiratory distress syndrome in cancer patients: Epidemiology, risk factors, and outcomes

2017 ◽  
Vol 42 ◽  
pp. 390
Author(s):  
Eduardo Mantovani Cardoso ◽  
Aniele Tomadon ◽  
Keli Lovison ◽  
Péricles Almeida Delfino Duarte
Keyword(s):  
Risk Factors ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Cancer Patients ◽  
Distress Syndrome

scholarly journals Acute respiratory distress syndrome mimickers lacking common risk factors of the Berlin definition

2015 ◽  
Vol 42 (2) ◽  
pp. 164-172 ◽  
Author(s):  
Aude Gibelin ◽  
Antoine Parrot ◽  
Bernard Maitre ◽  
Christian Brun-Buisson ◽  
Armand Mekontso Dessap ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Berlin Definition ◽  
Common Risk Factors

Pediatric trauma-associated acute respiratory distress syndrome: Incidence, risk factors, and outcomes

2019 ◽  
Vol 54 (7) ◽  
pp. 1405-1410 ◽  
Author(s):  
Amory de Roulet ◽  
Rita V. Burke ◽  
Joanna Lim ◽  
Stephanie Papillon ◽  
David W. Bliss ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Pediatric Trauma ◽  
Incidence Risk

scholarly journals Circulating nucleosomes are associated with mortality in pediatric acute respiratory distress syndrome

2016 ◽  
Vol 310 (11) ◽  
pp. L1177-L1184 ◽  
Author(s):  
Nadir Yehya ◽  
Neal J. Thomas ◽  
Susan S. Margulies
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Prospective Observational Study ◽  
Distress Syndrome ◽  
Severity Of Illness ◽  
Enzyme Linked Immunosorbent Assay ◽  
Potential Utility ◽  
Mechanistic Insight ◽  
Organ Failures

Mechanisms underlying pediatric acute respiratory distress syndrome (PARDS) are poorly understood. The recent implication of circulating nucleosomes as pathogenic in sepsis and trauma-associated ARDS in adults led us to investigate the significance of nucleosomes in PARDS. We conducted a prospective, observational study on children with PARDS at the Children's Hospital of Philadelphia between July 2014 and September 2015. Plasma was collected within 48 h of PARDS onset and nucleosomes quantified by enzyme-linked immunosorbent assay. Samples from 76 children with PARDS (11 deaths, 14%) were collected early [median 15 (IQR 7, 21) h] after PARDS onset. Nucleosome levels were higher in nonsurvivors [0.59 AU (IQR 0.46, 0.84)] relative to survivors [0.21 AU (IQR 0.08, 0.33), rank sum P < 0.001]. Nucleosome levels were not associated with either Berlin ( P = 0.845) or PALICC ( P = 0.886) oxygenation categories, nor with etiology of PARDS ( P = 0.527). Nucleosomes were correlated with increasing numbers of nonpulmonary organ failures ( P = 0.009 for trend), and were higher in patients whose PaO2/FiO2 worsened ( P = 0.012) over the first 72 h of PARDS. In regression analysis, nucleosome levels were independently associated with mortality after adjusting for either age, severity of illness score, number of nonpulmonary organ failures, vasopressor score, or PaO2/FiO2 (all P < 0.05). In conclusion, plasma nucleosome levels in early PARDS were associated with increased mortality, correlated with number of nonpulmonary organ failures, and preceded worsening oxygenation. The potential utility of this biomarker for prognostication, risk stratification, and mechanistic insight should be investigated further.

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