This study was undertaken to determine the incidence and potential risk factors associated with Acute Respiratory Distress Syndrome (ARDS) in pediatric oncologic patients undergoing invasive mechanical ventilation and the association between mortality risk factors and ARDS. Retrospective cohort study was conducted using data analysis of patients on admission to the PICU, that were submitted to invasive mechanical ventilation for over 24 hours. Shapiro-Wilk test and bivariate analysis within the group exposed to ARDS and the one not exposed, as well as Fisher's, Wilks G, chi-square tests, and Poisson logistic regression were applied, with significant variables p <0.05 and 95% CI. From que 181 pediatric cancer patients included in the study, 69.06% had ARDS, with 48% leukemia, 58.4% pneumonia, 60.8% febrile neutropenia, and 76.1% were in the maintenance chemotherapy phase; pH expressed higher relation with ARDS outcome and mortality. These data are important as this is one of the first studies carried out on ARDS in the pediatric cancer population in the North of Brazil, but further research is needed to better correlate risk factors and acute respiratory distress syndrome on such population.
Objectives: To determine blood glucose distribution values; to assess the association of admission serum glucose levels with 28-day mortality to the frequency of invasive mechanical ventilation-free days. Design: Retrospective cohort studySetting: Brazilian Amazon Region. Patients: Population (n = 400) composed of patients admitted to the pediatric intensive care unit, from January 2016 to December 2017. Exclusion criteria were patients with length of stay of <24 hours; diabetes mellitus; suspicion or evidence of inborn errors of metabolism; insulin use; palliative care and brain death. Main outcome measures: The patients were divided into 4 groups: 1) serum glucose <60mg/dL; 2) control group if serum glucose between 60-126 mg/dL; 3) between 127-150mg/dL; or 4) if > 150mg/dL. Results: Serum glucose levels frequency were: <60: 43 (11%); 60-126: 235 (58.7%); 127-150: 51 (13%) and > 150: 71 (18%). Groups 3 and 4 had the highest frequency of external origin, with respectively 24 (47.1%) and 40 (56.3%); the main diagnosis was infection, with 26 (51%) and 50 (70.4%), respectively. Sepsis occurred in 24 (47.1%) and 47 (66.2%) individuals in the groups 3 and 4, respectively, while septic shock was more frequent in the group 4 (46 [4.8%]). Group 2 had predominance of ventilator-associated pneumonia with 11 (36.7%). The estimate of ventilation-free days in group 4 was 2.84 (SD +/- 0.69; 95% CI: 1.5-4.2). Conclusion: Hyperglycemia group had a lower frequency of ventilation-free days and higher 28-day mortality.
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