Published ahead of print on December 23, 2004, doi:10.1164/rccm.200404-544OC
Am. J. Respir. Crit. Care Med., Volume 171, Number 9, May 2005, 995-1001
A more recent version of this article appeared on May 1, 2005
Submitted on April 27, 2004
Accepted on December 14, 2004
Pediatric Acute Lung Injury: Prospective Evaluation of Risk Factors Associated with Mortality
Heidi R Flori1*, David V Glidden2, George W Rutherford3, and Michael A Matthay4
1 Department of Critical Care, Children's Hospital and Research Center at Oakland, Oakland, CA, USA,
2 Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA,
3 Department of Pediatrics, University of California, San Francisco Medical Center, San Francisco, CA, USA,
4 Departments of Medicine and Anesthesia and the Cardiovascular Research Institute, University of California, San Francisco Medical Center, San Francisco, CA, USA
* To whom correspondence should be addressed. E-mail: hflori{at}mail.cho.org.
Rationale: The 1994 American European Consensus Committee definitions of acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) have not been applied systematically in the pediatric population. Objectives: The purpose of this study was to evaluate prospectively the epidemiology and clinical risk factors associated with death and prolonged mechanical ventilation in all pediatric patients admitted to two large, pediatric intensive care units with ALI/ARDS using Consensus criteria. Methods: All pediatric patients meeting Consensus Committee definitions for ALI were prospectively identified and included in a relational database. Measurements and Main Results: There were 328 admissions for ALI/ARDS with a mortality of 22%. Multivariate logistic regression analyses revealed that 1) the initial severity of oxygenation defect, as measured by the PaO2/FiO2 ratio, 2) the presence of non-pulmonary and non-central nervous system (CNS) organ dysfunction and 3) the presence of CNS dysfunction were independently associated with mortality and prolonged mechanical ventilation. A substantial fraction of patients (28%) did not require mechanical ventilation at the onset of ALI; 46% of these patients eventually required intubation for worsening ALI. Conclusions: Mortality in pediatric ALI/ARDS is high and several risk factors have major prognostic value. In contrast to ALI/ARDS in adults, the initial severity of arterial hypoxemia in children correlates well with mortality. A significant fraction of patients with pediatric ALI/ARDS can be identified before endotracheal intubation is required. These patients provide a valuable group in whom new therapies can be tested.
Key words: Acute Lung Injury, ARDS, Pediatric, Mortality
This article has been cited by other articles:
|
|
|
|
 
R. G. Khemani, B. P. Markovitz, and M. A. Q. Curley
Characteristics of Children Intubated and Mechanically Ventilated in 16 PICUs
Chest,
September 1, 2009;
136(3):
765 - 771.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Zimmerman, S. R. Akhtar, E. Caldwell, and G. D. Rubenfeld
Incidence and Outcomes of Pediatric Acute Lung Injury
Pediatrics,
July 1, 2009;
124(1):
87 - 95.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. E. Levitt, H. Bedi, C. S. Calfee, M. K. Gould, and M. A. Matthay
Identification of Early Acute Lung Injury at Initial Evaluation in an Acute Care Setting Prior to the Onset of Respiratory Failure
Chest,
April 1, 2009;
135(4):
936 - 943.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. G. Khemani, N. R. Patel, R. D. Bart III, and C. J. L. Newth
Comparison of the Pulse Oximetric Saturation/Fraction of Inspired Oxygen Ratio and the PaO2/Fraction of Inspired Oxygen Ratio in Children
Chest,
March 1, 2009;
135(3):
662 - 668.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. J. H. Taut, G. Rippin, P. Schenk, G. Findlay, W. Wurst, D. Hafner, J. F. Lewis, W. Seeger, A. Gunther, and R. G. Spragg
A Search for Subgroups of Patients With ARDS Who May Benefit From Surfactant Replacement Therapy: A Pooled Analysis of Five Studies With Recombinant Surfactant Protein-C Surfactant (Venticute)
Chest,
October 1, 2008;
134(4):
724 - 732.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. D. Liu and M. A. Matthay
Advances in Critical Care for the Nephrologist: Acute Lung Injury/ARDS
Clin. J. Am. Soc. Nephrol.,
March 1, 2008;
3(2):
578 - 586.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. M. Alvira, A. Abate, G. Yang, P. A. Dennery, and M. Rabinovitch
Nuclear Factor-{kappa}B Activation in Neonatal Mouse Lung Protects against Lipopolysaccharide-induced Inflammation
Am. J. Respir. Crit. Care Med.,
April 15, 2007;
175(8):
805 - 815.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. L. Bratton
Fluid Therapy for Acute Lung Injury
AAP Grand Rounds,
November 1, 2006;
16(5):
53 - 54.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. B. Milbrandt, A. Ishizaka, and D. C. Angus
Update in critical care 2005.
Am. J. Respir. Crit. Care Med.,
April 15, 2006;
173(8):
833 - 841.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. M. Ventre
Oxygenation Index Predicts Outcome of Acute Hypoxemic Respiratory Failure
AAP Grand Rounds,
February 1, 2006;
15(2):
20 - 21.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Matthay and G. A. Zimmerman
Acute Lung Injury and the Acute Respiratory Distress Syndrome: Four Decades of Inquiry into Pathogenesis and Rational Management
Am. J. Respir. Cell Mol. Biol.,
October 1, 2005;
33(4):
319 - 327.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. P. Kavanagh
Prone Positioning in Children With ARDS: Positive Reflections on a Negative Clinical Trial
JAMA,
July 13, 2005;
294(2):
248 - 250.
[Full Text]
[PDF]
|
|
|
Copyright © 2004 American Thoracic Society
|
|
|
