Author Of 2 Presentations
LUNG PROTECTIVE VENTILATION STRATEGIES ARE NOT ASSOCIATED WITH IMPROVED SURVIVAL IN PEDIATRIC ACUTE RESPIRATORY DISTRESS SYNDROME
Abstract
Background
Lung-protective mechanical ventilation (MV) strategies are associated with survival benefits in adults.
Objectives
We aim to determine if a greater degree of adherence to the Pediatric Acute Lung Injury Consensus Conference (PALICC) ventilation recommendations would result in improved survival in pediatric acute respiratory distress syndrome (PARDS).
Methods
Patients with PARDS were included in this prospective cohort study. Adherent days were defined as days where at least three out of five of the following conventional MV (CMV) strategies were adhered to on the first seven days of PARDS: (1) peak inspiratory pressures <28cmH2O, (2) tidal volumes <6ml/kg, (3) positive end expiratory pressure to fraction of inspired oxygen table, (4) permissive hypercapnia (pH 7.20-7.30) and (5) permissive hypoxia (93-97% for mild, 88-92% for moderate/severe PARDS). Logistic regression was used to evaluate the impact of “adherence” on pediatric intensive care unit (PICU) mortality, adjusting for PARDS severity.
Results
Forty-seven patients were recruited over a year. Overall median (interquartile range) age and Pediatric Index of Mortality 2 score were 2.3(0.4, 6.6) years and 9.3(3.2, 27.6) %. The median oxygenation index was 6.5 (4.9, 10.9) and there were 8/47(19.5%) patients with severe PARDS. PICU mortality was 7/47(14.9%). There was a total of 192/253(75.9%) CMV days. The median number of adherent days was 1 (0, 3). The number of days adherent to ventilatory recommendations was not associated with PICU mortality [adjusted odds ratio 1.1 (95%confidence interval 0.9, 1.3); p=0.459].
Conclusion
In PARDS, a greater degree of adherence to the PALICC CMV recommendations was not associated with improved PICU mortality.
CLINICAL CHALLENGES AND LIMITATIONS OF THE CURRENT PEDIATRIC ACUTE RESPIRATORY DISTRESS SYNDROME DEFINITION
Abstract
Background
The Pediatric Acute Lung Injury Consensus Conference (PALICC) definition is currently used to diagnose pediatric acute respiratory distress syndrome (PARDS).
Objectives
We aimed to determine the clinical characteristics of patients identified to have PARDS and evaluate whether these patients could be better defined by alternative diagnoses.
Methods
We screened all pediatric intensive care unit (PICU) admissions daily over a year (2018). Patients who fulfilled the PALICC definition were prospectively recruited. We interrogated the clinical history and course of illness to identify factors which (1) made the diagnosis of PARDS unlikely or (2) altered the course of illness in patients with PARDS.
Results
Over the one-year period, there were 594 PICU admissions. 47/594(8%) patients were identified to have PARDS. Despite meeting the PALICC criteria, 5/47(11%) patients were suspected to have alternate diagnosis to PARDS [congestive cardiac failure/ fluid overload (despite normal 2D-echocardiography), pulmonary hypertension, pulmonary hemorrhage, lung contusion with drained hemopneumothorax]. 28/47(60%) patients had underlying comorbidities, of which 8/47(17%) were likely to confound the evolution of PARDS – these were patients who had underlying pulmonary hemosiderosis, pulmonary lymphangiectasia, restrictive lung disease and immunodeficiency. Together, these patients were more likely to develop severe PARDS [5/13(38%) vs 3/34(9%); p=0.028], and had increased mortality [4/13(30%) vs 3/34(9%); p=0.080] compared to the general PARDS cohort, though it was not statistically significant.
Conclusion
A significant proportion of patients fulfilling criteria for PARDS are suspected to have alternate diagnoses (false positives) or underlying diseases that potentially alter the course of illness.