Abstract
OBJECTIVES—To determine the incidence and outcome of acute respiratory distress syndrome (ARDS) in children by comparing two commonly used definitions: the lung injury score and the American-European Consensus Conference definition. The causes and risk for developing ARDS were also studied. METHODS—Part prospective and retrospective analysis of 8100 consecutive hospital admissions from 1 June 1995 to 1 April 1997. RESULTS—Twenty one patients fulfilled the criteria for ARDS. Both definitions identified the same group of patients. The incidence was 2.8/1000 hospital admissions or 4.2% of paediatric intensive care unit admissions. The main causes were sepsis and pneumonia. Mortality was 13 of 21. Factors predicting death were a high admission paediatric risk of mortality (PRISM) score (30.38 v 18.75) and the presence of multiple organ dysfunction syndrome (92% v 25%). CONCLUSION—Both definitions identified similar groups of patients. The incidence in this population was higher than that reported elsewhere, but mortality and cause were similar to those in developed countries. Poor outcome was associated with sepsis, a high admission PRISM score, and simultaneous occurrence of other organ dysfunction.
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- Ashbaugh D. G., Bigelow D. B., Petty T. L., Levine B. E. Acute respiratory distress in adults. Lancet. 1967 Aug 12;2(7511):319–323. doi: 10.1016/s0140-6736(67)90168-7. [DOI] [PubMed] [Google Scholar]
- Ashbaugh D. G., Petty T. L., Bigelow D. B., Harris T. M. Continuous positive-pressure breathing (CPPB) in adult respiratory distress syndrome. J Thorac Cardiovasc Surg. 1969 Jan;57(1):31–41. [PubMed] [Google Scholar]
- Bernard G. R., Artigas A., Brigham K. L., Carlet J., Falke K., Hudson L., Lamy M., Legall J. R., Morris A., Spragg R. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):818–824. doi: 10.1164/ajrccm.149.3.7509706. [DOI] [PubMed] [Google Scholar]
- Costil J., Cloup M., Leclerc F., Devictor D., Beaufils F., Siméoni U., Berthier J. C., Berner M., Teyssier G., Rousselot J. M. Acute respiratory distress syndrome (ARDS) in children: Multicenter Collaborative Study of the French Group of Pediatric Intensive Care. Pediatr Pulmonol Suppl. 1995;11:106–107. doi: 10.1002/ppul.1950191152. [DOI] [PubMed] [Google Scholar]
- Effmann E. L., Merten D. F., Kirks D. R., Pratt P. C., Spock A. Adult respiratory distress syndrome in children. Radiology. 1985 Oct;157(1):69–74. doi: 10.1148/radiology.157.1.4034980. [DOI] [PubMed] [Google Scholar]
- Garber B. G., Hébert P. C., Yelle J. D., Hodder R. V., McGowan J. Adult respiratory distress syndrome: a systemic overview of incidence and risk factors. Crit Care Med. 1996 Apr;24(4):687–695. doi: 10.1097/00003246-199604000-00023. [DOI] [PubMed] [Google Scholar]
- Holbrook P. R., Taylor G., Pollack M. M., Fields A. I. Adult respiratory distress syndrome in children. Pediatr Clin North Am. 1980 Aug;27(3):677–685. doi: 10.1016/s0031-3955(16)33902-5. [DOI] [PubMed] [Google Scholar]
- Hudson L. D., Milberg J. A., Anardi D., Maunder R. J. Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care Med. 1995 Feb;151(2 Pt 1):293–301. doi: 10.1164/ajrccm.151.2.7842182. [DOI] [PubMed] [Google Scholar]
- Krafte-Jacobs B., Pollack M. M. Multiple organ system failure in children. Crit Care Med. 1994 Jun;22(6):903–904. doi: 10.1097/00003246-199406000-00002. [DOI] [PubMed] [Google Scholar]
- Kraus P. A., Lipman J., Lee C. C., Wilson W. E., Scribante J., Barr J., Mathivha L. R., Brown J. M. Acute lung injury at Baragwanath ICU. An eight-month audit and call for consensus for other organ failure in the adult respiratory distress syndrome. Chest. 1993 Jun;103(6):1832–1836. doi: 10.1378/chest.103.6.1832. [DOI] [PubMed] [Google Scholar]
- Lum L. C., Thong M. K., Cheah Y. K., Lam S. K. Dengue-associated adult respiratory distress syndrome. Ann Trop Paediatr. 1995 Dec;15(4):335–339. doi: 10.1080/02724936.1995.11747794. [DOI] [PubMed] [Google Scholar]
- Lyrene R. K., Truog W. E. Adult respiratory distress syndrome in a pediatric intensive care unit: predisposing conditions, clinical course, and outcome. Pediatrics. 1981 Jun;67(6):790–795. [PubMed] [Google Scholar]
- Meduri G. U., Belenchia J. M., Estes R. J., Wunderink R. G., el Torky M., Leeper K. V., Jr Fibroproliferative phase of ARDS. Clinical findings and effects of corticosteroids. Chest. 1991 Oct;100(4):943–952. doi: 10.1378/chest.100.4.943. [DOI] [PubMed] [Google Scholar]
- Moss M., Goodman P. L., Heinig M., Barkin S., Ackerson L., Parsons P. E. Establishing the relative accuracy of three new definitions of the adult respiratory distress syndrome. Crit Care Med. 1995 Oct;23(10):1629–1637. doi: 10.1097/00003246-199510000-00006. [DOI] [PubMed] [Google Scholar]
- Murray J. F., Matthay M. A., Luce J. M., Flick M. R. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988 Sep;138(3):720–723. doi: 10.1164/ajrccm/138.3.720. [DOI] [PubMed] [Google Scholar]
- Nussbaum E. Adult-type respiratory distress syndrome in children. Experience with seven cases. Clin Pediatr (Phila) 1983 Jun;22(6):401–406. doi: 10.1177/000992288302200601. [DOI] [PubMed] [Google Scholar]
- Pearson G., Shann F., Barry P., Vyas J., Thomas D., Powell C., Field D. Should paediatric intensive care be centralised? Trent versus Victoria. Lancet. 1997 Apr 26;349(9060):1213–1217. doi: 10.1016/S0140-6736(96)12396-5. [DOI] [PubMed] [Google Scholar]
- Pfenninger J., Gerber A., Tschäppeler H., Zimmermann A. Adult respiratory distress syndrome in children. J Pediatr. 1982 Sep;101(3):352–357. doi: 10.1016/s0022-3476(82)80057-7. [DOI] [PubMed] [Google Scholar]
- Pollack M. M., Patel K. M., Ruttimann U. E. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med. 1996 May;24(5):743–752. doi: 10.1097/00003246-199605000-00004. [DOI] [PubMed] [Google Scholar]
- Pollack M. M., Ruttimann U. E., Getson P. R. Pediatric risk of mortality (PRISM) score. Crit Care Med. 1988 Nov;16(11):1110–1116. doi: 10.1097/00003246-198811000-00006. [DOI] [PubMed] [Google Scholar]
- Proulx F., Fayon M., Farrell C. A., Lacroix J., Gauthier M. Epidemiology of sepsis and multiple organ dysfunction syndrome in children. Chest. 1996 Apr;109(4):1033–1037. doi: 10.1378/chest.109.4.1033. [DOI] [PubMed] [Google Scholar]
- Proulx F., Gauthier M., Nadeau D., Lacroix J., Farrell C. A. Timing and predictors of death in pediatric patients with multiple organ system failure. Crit Care Med. 1994 Jun;22(6):1025–1031. doi: 10.1097/00003246-199406000-00023. [DOI] [PubMed] [Google Scholar]
- Randle C. J., Jr, Frankel L. R., Amylon M. D. Identifying early predictors of mortality in pediatric patients with acute leukemia and pneumonia. Chest. 1996 Feb;109(2):457–461. doi: 10.1378/chest.109.2.457. [DOI] [PubMed] [Google Scholar]
- Shann F., Pearson G., Slater A., Wilkinson K. Paediatric index of mortality (PIM): a mortality prediction model for children in intensive care. Intensive Care Med. 1997 Feb;23(2):201–207. doi: 10.1007/s001340050317. [DOI] [PubMed] [Google Scholar]
- Suter P. M., Domenighetti G., Schaller M. D., Laverrière M. C., Ritz R., Perret C. N-acetylcysteine enhances recovery from acute lung injury in man. A randomized, double-blind, placebo-controlled clinical study. Chest. 1994 Jan;105(1):190–194. doi: 10.1378/chest.105.1.190. [DOI] [PubMed] [Google Scholar]
- Wilkinson J. D., Pollack M. M., Ruttimann U. E., Glass N. L., Yeh T. S. Outcome of pediatric patients with multiple organ system failure. Crit Care Med. 1986 Apr;14(4):271–274. doi: 10.1097/00003246-198604000-00002. [DOI] [PubMed] [Google Scholar]