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. 2013 Dec 27;24(7):699–705. doi: 10.1007/s001340050647

Acute hypoxemic respiratory failure in children: case mix and the utility of respiratory severity indices

M J Peters 1,2, R C Tasker 1,2,✉, K M Kiff 1, R Yates 1, D J Hatch 2
PMCID: PMC7094931  PMID: 9722040

Abstract

Objective: Acute hypoxemic respiratory failure (AHRF) is a common reason for emergency pediatric intensive care. An objective assessment of disease severity from acute physiological parameters would be of value in clinical practice and in the design of clinical trials. We hypothesised that there was a difference in the best early respiratory indices in those who died compared with those who survived.

Design: A prospective observational study of 118 consecutive AHRF admissions with data analysis incorporating all blood gases.

Setting: A pediatric intensive care unit in a national children’s hospital.

Interventions: None.

Results: Mortality was 26/118,22% (95% confidence interval 18–26%). There were no significant differences in the best alveolar-arterial oxygen tension gradient (A-aDO2, torr), oxygenation index (OI), ventilation index (VI), or PaO2/FIO2 during the first 2 days of intensive care between the survivors and non-survivors. Only the mean airway pressure (MAP, cm H2O) used for supportive care was significantly different on days 0 and 1 (p≤0.05) with higher pressure being used in non-survivors. Multiple logistic regression analysis did not identify any gas exchange or ventilator parameter independently associated with mortality. Rather, all deaths were associated with coincident pathology or multi-organ system failure, or perceived treatment futility due to pre-existing diagnoses instead of unsupportable respiratory failure. When using previously published predictors of outcome (VI>40 and OI>40; A-aDO2>450 for 24 h; A-aDO2>470 or MAP>23; or A-aDO2>420) the risk of mortality was overestimated significantly in the current population.

Conclusion: The original hypothesis was refuted. It appears that the outcome of AHRF in present day pediatric critical care is principally related to the severity of associated pathology and now no longer solely to the severity of respiratory failure. Further studies in larger series are needed to confirm these findings.

Key words: Respiratory failure, Mechanical ventilation, Lung disease, Pediatrics

References

  • 1.Lyrene RK, Truog WE. Adult respiratory distress syndrome in a pediatric intensive care unit: predisposing conditions, clinical course and outcome. Pediatrics. 1981;67:790–795. [PubMed] [Google Scholar]
  • 2.Rivera RA, Butt W, Shann F. Predictors of mortality in children with respiratory failure; possible indications for ECMO. Anaesth Intensive Care. 1990;18:385–389. doi: 10.1177/0310057X9001800316. [DOI] [PubMed] [Google Scholar]
  • 3.Tamburro RF, Bugnitz MC, Stidham GL. Alveolar-arterial oxygen gradient as a predictor of outcome in patients with non-neonatal respiratory failure. J Pediatr. 1991;119:935–938. doi: 10.1016/S0022-3476(05)83048-3. [DOI] [PubMed] [Google Scholar]
  • 4.Timmons OD, Dean M, Vernon DD. Mortality rates and prognostic variables in children with adult respiratory distress syndrome. J Pediatr. 1991;119:896–899. doi: 10.1016/S0022-3476(05)83039-2. [DOI] [PubMed] [Google Scholar]
  • 5.Davis SL, Furman DP, Costarino AT. Adult respiratory distress syndrome in children: associated diseases, clinical course and predictors of death. J Pediatr. 1993;123:35–45. doi: 10.1016/S0022-3476(05)81534-3. [DOI] [PubMed] [Google Scholar]
  • 6.Timmons OD, Havens PL, Fackler JC, the Pediatric Critical Care Study Group and the Extracorporeal Life Support Organisation Predicting death in pediatric patients with acute respiratory failure. Chest. 1995;108:789–797. doi: 10.1378/chest.108.3.789. [DOI] [PubMed] [Google Scholar]
  • 7.Hammer J, Numa A, Newth CJL. Acute respiratory distress syndrome caused by respiratory syncytial virus. Pediatr Pulmonol. 1997;23:176–183. doi: 10.1002/(SICI)1099-0496(199703)23:3<176::AID-PPUL2>3.0.CO;2-M. [DOI] [PubMed] [Google Scholar]
  • 8.Goldman AP, Tasker RC, Hosiasson S, Henrichsen T, Macrae DJ. Early response to inhaled nitric oxide and its relationship to outcome in children with severe hypoxemic respiratory failure. Chest. 1997;112:752–758. doi: 10.1378/chest.112.3.752. [DOI] [PubMed] [Google Scholar]
  • 9.Sarnaik AP, Meert KL, Pappas MD, Simpson PM, Lieh-Lai MW, Heider-mann SM. Predicting outcome in children with severe acute respiratory failure treated with high-frequency ventilation. Crit Care Med. 1996;24:1396–1402. doi: 10.1097/00003246-199608000-00020. [DOI] [PubMed] [Google Scholar]
  • 10.Bernard GR, Artigas A, Brigham KL, et al. The American-European consensus conference on ARDS: Definitions, mechanisms, relevant outcomes and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818–824. doi: 10.1164/ajrccm.149.3.7509706. [DOI] [PubMed] [Google Scholar]
  • 11.Wilkinson JD, Pollock MM, Ruttiman UE, Glass NL, Yeh TS. Outcome of pediatric patients with multiple organ system failure. Crit Care Med. 1986;14:271–274. doi: 10.1097/00003246-198604000-00002. [DOI] [PubMed] [Google Scholar]
  • 12.Jimenez P, Torres A, Roca J, Cobos A, Rodriquez-Roisin R. Arterial oxygenation does not predict the outcome of patients with acute respiratory failure needing mechanical ventilation. Eur Respir J. 1994;7:730–735. doi: 10.1183/09031936.94.07040730. [DOI] [PubMed] [Google Scholar]
  • 13.Ferring M, Vincent J-L. Is outcome from ARDS related to the severity of respiratory failure? Eur Respir J. 1997;10:1297–1300. doi: 10.1183/09031936.97.10061297. [DOI] [PubMed] [Google Scholar]
  • 14.Vincent J-L. Outcome from mechanical ventilation. Eur Respir J. 1994;7:640–642. doi: 10.1183/09031936.94.07040640. [DOI] [PubMed] [Google Scholar]
  • 15.Pollack MM, Patel KM, Ruttimann UE. PRISM III: An updated pediatric risk of mortality score. Crit Care Med. 1996;24:743–752. doi: 10.1097/00003246-199605000-00004. [DOI] [PubMed] [Google Scholar]
  • 16.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;23:201–207. doi: 10.1007/s001340050317. [DOI] [PubMed] [Google Scholar]
  • 17.Rowan KM, Kerr JH, Major F, McPher-son K, Short A, Vessey MP. Intensive Care Society’s APACHE II study in Britain and Ireland — I: Variations in case mix of adult admissions to general intensive care units and impact on outcome. BMJ. 1993;307:972–977. doi: 10.1136/bmj.307.6910.972. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Petros AJ, Marshall JC, Van Saene HKF. Should morbidity replace mortality as an end point for clinical trials in intensive care? Lancet. 1995;345:369–371. doi: 10.1016/S0140-6736(95)90347-X. [DOI] [PubMed] [Google Scholar]

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