Outcomes of Children With Critical Bronchiolitis Meeting at Risk for Pediatric Acute Respiratory Distress Syndrome Criteria.

Autor:	Slain KN; Division of Critical Care, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH.; Case Western Reserve University School of Medicine, Cleveland, OH., Rotta AT; Division of Critical Care, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH.; Case Western Reserve University School of Medicine, Cleveland, OH., Martinez-Schlurmann N; Division of Critical Care, Department of Pediatrics, University of Florida Health Shands Children's Hospital, Gainesville, FL., Stormorken AG; Division of Critical Care, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH.; Case Western Reserve University School of Medicine, Cleveland, OH., Shein SL; Division of Critical Care, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH.; Case Western Reserve University School of Medicine, Cleveland, OH.
Jazyk:	angličtina
Zdroj:	Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2019 Feb; Vol. 20 (2), pp. e70-e76.
DOI:	10.1097/PCC.0000000000001812
Abstrakt:	Objectives: New definitions of pediatric acute respiratory distress syndrome include criteria to identify a subset of children "at risk for pediatric acute respiratory distress syndrome." We hypothesized that, among PICU patients with bronchiolitis not immediately requiring invasive mechanical ventilation, those meeting at risk for pediatric acute respiratory distress syndrome criteria would have worse clinical outcomes, including higher rates of pediatric acute respiratory distress syndrome development. Design: Single-center, retrospective chart review. Setting: Mixed medical-surgical PICU within a tertiary academic children's hospital. Patients: Children 24 months old or younger admitted to the PICU with a primary diagnosis of bronchiolitis from September 2013 to April 2014. Children intubated before PICU arrival were excluded. Interventions: None. Measurements and Main Results: Collected data included demographics, respiratory support, oxygen saturation, and chest radiograph interpretation by staff radiologist. Oxygen flow (calculated as FIO2 × flow rate [L/min]) was calculated when oxygen saturation was 88-97%. The median age of 115 subjects was 5 months (2-11 mo). Median PICU length of stay was 2.8 days (1.5-4.8 d), and median hospital length of stay was 5 days (3-10 d). The criteria for at risk for pediatric acute respiratory distress syndrome was met in 47 of 115 subjects (40.9%). Children who were at risk for pediatric acute respiratory distress syndrome were more likely to develop pediatric acute respiratory distress syndrome (15/47 [31.9%] vs 1/68 [1.5%]; p < 0.001), had longer PICU length of stay (4.6 d [2.8-10.2 d] vs 1.9 d [1.0-3.1 d]; p < 0.001) and hospital length of stay (8 d [5-16 d] vs 4 d [2-6 d]; p < 0.001), and increased need for invasive mechanical ventilation (16/47 [34.0%] vs 2/68 [2.9%]; p < 0.001), compared with those children who did not meet at risk for pediatric acute respiratory distress syndrome criteria. Conclusions: Our data suggest that the recent definition of at risk for pediatric acute respiratory distress syndrome can successfully identify children with critical bronchiolitis who have relatively unfavorable clinical courses.
Databáze:	MEDLINE
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