Evaluation of acute respiratory distress syndrome cases in a pediatric intensive care unit

Year 2021, , 516 - 522, 30.06.2021

İnci Turhan Dinçer Yıldızdaş , Ahmet Yöntem

https://doi.org/10.17826/cumj.850659

Abstract

Purpose: The aim of this study was to evaluate the lung-protective mechanical ventilation strategy, early enteral nutrition, negative fluid balance, and adequacy of hospital resources in our pediatric intensive care unit.
Materials and Methods: This study included 32 patients who developed acute respiratory distress syndrome (ARDS) during their monitoring in the pediatric intensive care unit.
Results: According to their oxygenation status, 14 patients (43.8%) had mild ARDS, nine patients (28.1%) had moderate ARDS, and nine patients (28.1%) had severe ARDS. High-frequency oscillatory ventilation was applied to three patients (9.3%), and four patients (12.5%) received extracorporeal membrane oxygenation (ECMO) support. The most common complications were nosocomial infection (31.3%) and pneumothorax (12.5%). The mortality rate was 6.3%. The survival rate was 75.0% in patients with ECMO support. The patients with a higher Pediatric Index of Mortality (PIM-2) score confronted more severe ARDS, and non-pulmonary ARDS also progressed in advanced stages.
Conclusion: In patients with high PIM-2 and PELOD scores, attention must be given to the development of severe ARDS. The lung-protective mechanical ventilation support, early enteral nutrition, negative fluid balance practices, and the adequacy of hospital resources led to a successful survival rate in our study. However, multicenter randomized controlled trials are needed on this subject.

Keywords

Acute Respiratory Distress Syndrome, PICU, Children, Stage, Survival

Çocuk yoğun bakım ünitesindeki akut solunum sıkıntısı sendromu vakalarının değerlendirilmesi

Abstract

Amaç: Bu çalışmanın amacı akciğer koruyucu mekanik ventilasyon stratejisi, erken enteral beslenme, negatif sıvı dengesi ve hasta kaynaklarının yeterliliğinin akut solunum sıkıntısı sendromu olan çocuklarda sağ kalım üzerine etkisini değerlendirmektir.
Gereç ve Yöntem: Çalışmaya çocuk yoğun bakım ünitemizde akut solunum sıkıntısı sendromu gelişen 32 hasta dahil edildi.
Bulgular: Oksijenizasyon durumlarına göre 14’ü hafif (% 43.8), 9’u orta (% 28.1) ve 9’u ağır (% 28.1) evre akut solunum sıkıntısı sendromu gelişmiş idi. Üç hastaya (% 9,4) yüksek frekanslı osilasyon ventilasyon, dört (% 12,5) hastaya ekstrakorporeal membran oksjenizasyon desteği sağlandı. En sık görülen komplikasyonlar ventilatör ilişkili pnömoni (% 21.9) ve pnömotoraks (% 12.5) idi. Mortalite oranı % 6.3 idi. Ekstrakorporeal membran oksjenizasyon uygulanan hastalarda sağ kalım oranı %75 idi. Pediatric Index of Mortality-2 skoru yüksek olan ve non-pulmoner kaynaklı akut solunum sıkıntısı sendromu hastaların takibi sırasında gelişebilecek akut solunum sıkıntısı sendromunun şiddetinin daha ağır olduğu görüldü.
Sonuç: Akciğer koruyucu mekanik ventilasyon desteği, erken enteral beslenme, negatif sıvı dengesi ve yeterli hastane kaynakları sağkalımı arttırabilir. Ancak, çok merkezli randomize kontrollü çalışmalara ihtiyaç vardır.

Keywords

Akut Solunum Sıkıntısı Sendromu, Çocuk, Çocuk Yoğun Bakım

References

• Referans1 Khemani RG, Smith LS, Zimmerman JJ, Erickson S; Pediatric Acute Lung Injury Consensus Conference Group. Pediatric Acute Lung Injury Consensus Conference Group: Pediatric acute respiratory distress syndrome: Definition, incidence, and epidemiology: Proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015;16:23–40.
• Referans2 Khemani RG, Smith L, Lopez-Fernandez YM, Kwok J, Morzov R, Klein MJ, et al. Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE): An international, observational study. Lancet Respir Med 2019;7:115–28.
• Referans3 López-Fernández Y, Azagra AM, de la Oliva P, Modesto V, Sánchez JI, Parrilla J, et al. Pediatric Acute Lung Injury Epidemiology and Natural History study: Incidence and outcome of the acute respiratory distress syndrome in children. Crit Care Med 2012;40:3238-45.
• Referans4 Kneyber MC, Brouwers AG, Caris JA, Chedamni S, Plötz FB. Acute respiratory distress syndrome: is it underrecognized in the pediatric intensive care unit?. Intensive Care Med 2008;34:751-4.
• Referans5 Dowell JC, Parvathaneni K, Thomas NJ, Khemani RG, Yehya N. Epidemiology of cause of death in pediatric acute respiratory distress syndrome. Crit Care Med 2018;46:1811–9.
• Referans6 Yadav B, Bansal A, Jayashree M. Clinical Profile and Predictors of Outcome of Pediatric Acute Respiratory Distress Syndrome in a PICU: A Prospective Observational Study. Pediatr Crit Care Med 2019;20:263–73.
• Referans7 Villar J, Blanco J, Añón JM, Santos-Bouza A, Blanch L, Ambrós A, et al. The ALIEN study: Incidence and outcome of acute respiratory distress syndrome in the era of lung-protective ventilation. Intensive Care Med 2011;37:1932–41.
• Referans8 Villar J, Blanco J, Kacmarek RM. Current incidence and outcome of the acute respiratory distress syndrome. Curr Opin Crit Care 2016;22:1–6.
• Referans9 Ten I, Torres A. Pediatric Acute Respiratory Distress Syndrome Mortality in the 21st Century: Nature, Nurture, Location, and?. Pediatr Crit Care Med 2019;20:584–5.
• Referans10 Thomas NJ, Shaffer ML, Willson DF, Shih MC, Curley MA. Defining acute lung disease in children with the oxygenation saturation index. Pediatr Crit Care Med 2010;11:12–7.
• Referans11 Khemani RG, Thomas NJ, Venkatachalam V, Scimeme JP, Berutti T, Schneider JB, et al. Comparison of Spo2 to Pao2 based markers of lung disease severity for children with acute lung injury. Crit Care Med 2012;40:1309–16.
• Referans12 Slater A, Shann F, Pearson G. Paediatric Index of Mortality (PIM) Study Group: PIM2: A revised version of the Paediatric Index of Mortality. Intensive Care Med 2003;29:278–85.
• Referans13 Leteurtre S, Martinot A, Duhamel A, Gauvin F, Grandbastien B, Nam TV, et al. Development of pediatric multiple organ dysfunction score: Use of two strategies. Med Decis Making 1999;19:399–410.
• Referans14 Yehya N, Harhay MO, Klein MJ, Shein SL, Piñeres-Olave BE, Izquierdo L, et al. Predicting Mortality in Children With Pediatric Acute Respiratory Distress Syndrome: A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study. Crit Care Med 2020 Apr. 8. doi: 10.1097/CCM.0000000000004345.
• Referans15 Quasney MW, López-Fernández YM, Santschi M, Watson RS; Pediatric Acute Lung Injury Consensus Conference Group. The outcomes of children with pediatric acute respiratory distress syndrome: Proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015;16:118–31.
• Referans16 Wong JJM, Lee SW, Tan HL, Ma YJ, Sultana R, Mok YH, et al. Lung-Protective Mechanical Ventilation Strategies in Pediatric Acute Respiratory Distress Syndrome. Pediatr Crit Care Med 2020 Mar. 20. doi: 10.1097/PCC.0000000000002324.
• Referans17 Hu X, Qian S, Xu F, Huang B, Zhou D, Wang Y, et al. Chinese Collaborative Study Group for Pediatric Respiratory Failure: Incidence, management and mortality of acute hypoxemic respiratory failure and acute respiratory distress syndrome from a prospective study of Chinese paediatric intensive care network. Acta Paediatr 2010;99:715–21.