Characterizing Degree of Lung Injury in Pediatric Acute Respiratory Distress Syndrome

Yehya, Nadir; Servaes, Sabah; Thomas, Neal J.

doi:10.1097/ccm.0000000000000867

Cited by 100 publications

(155 citation statements)

References 34 publications

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“…9 More recently, the PALICC OI-based severity stratification categories of PARDS were assessed and validated to indicate the highest risk of death in the severe category with OI>16. 10 Our study expands upon previously reported data on increased mortality risk with lower levels of OI than have been historically used for ECMO candidacy. 11 It also supports and provides additional validation of PALICC PARDS OI thresholds for increased risk of death.…”

supporting

confidence: 67%

“…In addition, use of lower OI's for entry criteria into clinical studies of pediatric respiratory failure may also be warranted. 6,[10][11][12][13] This threshold OI finding warrants further investigation with larger data sets from multiple centers. Review of the patient EMR had limited capability in calculating OI.…”

Section: Discussionmentioning

confidence: 99%

“…This report validates other recent single center studies and the international PALICC group that lower value OIs may be associated with adverse outcome. 6,7,10 Quantifying the predictive capability of the OI and identifying a threshold value for escalation of therapy will help guide discussion regarding appropriate time of rescue intervention. In addition, use of lower OI's for entry criteria into clinical studies of pediatric respiratory failure may also be warranted.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, use of lower OI's for entry criteria into clinical studies of pediatric respiratory failure may also be warranted. 6,10,12,13,15 Ongoing evaluation of other parameters of respiratory failure such as the oxygen saturation index may also be obtained from the EMR.…”

Section: Future Directionsmentioning

confidence: 99%

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Identifying an Oxygenation Index Threshold for Increased Mortality in Acute Respiratory Failure

Hammond

Garcia-Filion²,

Kang

et al. 2017

Respir Care

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Objectives: To examine current oxygenation index (OI) data and outcomes using EMR data to identify a specific OI values associated with outcome. Methods:Retrospective review of electronic medical record (EMR) data for patients age 1 month -20 years mechanically ventilated for >24 hours in the PICU. Serial, average and maximum OI values were calculated. Length of mechanical ventilation, hospital stay and outcome were assessed.Results: OI was calculated on 65 patients from EMR data, of which 6 died (9.2%). The median maximum OI was 10 for all patients, 17 for non-survivors (NS), and 8 for survivors (S), (p=0.14 via Wilcoxon rank-sum test). Odds ratios (OR) indicated 2.1 times increase odds of death (p=.08), 95% confidence interval (0.89-5.03) for each one-percent increase in maximum OI.Average OI OR also revealed 2.1 times increase in odds of death (p=.14), 95% confidence interval (0.77-5.48). ROC analysis indicated a higher discriminate ability for max OI (AUC = 0.68) than average OI (AUC = .58). OI cut points for mortality were established. Mortality was unchanged until max OI >17, for which mortality nearly tripled at a value of 18% versus 6-7% for range 0-17. Conclusions:Serial assessment of OI values may allow creation of alert values for increased mortality risk and aid in development of clinical decision rules. Consideration for escalation of therapies for respiratory failure such as high frequency ventilation or ECMO at lower levels of OI than historically reported may be warranted. This study also helps to validate prior reports that OI is useful as a severity score for clinical research and outcome prediction.

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supporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Future Directionsmentioning

confidence: 99%

See 2 more Smart Citations

Identifying an Oxygenation Index Threshold for Increased Mortality in Acute Respiratory Failure

Hammond

Garcia-Filion²,

Kang

et al. 2017

Respir Care

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“…Yehya et al 14 examined subjects in a single center and compared them with some of the findings in the PALICC reports. The timing of their study, appearing at about the same time as the PALICC supplement, brings some validation to the recommendations by the PALICC group.…”

Section: Characterizing Acute Lung Injurymentioning

confidence: 99%

Year in Review 2015: Extracorporeal Membrane Oxygenation

Raman

Dalton

2016

Respir Care

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SummaryExtracorporeal membrane oxygenation (ECMO) is a modified form of cardiopulmonary bypass. Although early trials were plagued by severe bleeding and high rates of death, subsequent experience with neonates found good survival, and ECMO became an important tool in the care of critically ill infants with respiratory failure. Since the 1980s, expansion to other groups (children, patients with cardiac disease, etc) followed as experience was obtained. Today, there is a rapid growth of ECMO, especially in the adult population. To date, >73,000 patients receiving ECMO have been reported to the international Extracorporeal Life Support Organization registry. This rapid growth in the usage of ECMO has made it possible for it to be included in the management algorithm of certain disease processes, such as ARDS, cardiopulmonary arrest, and septic shock. Significant advances in technology have made it possible to support patients on ECMO for weeks or months with success. Reduction in sedative use and experience with "awake" patients has led to ambulatory and mobile ECMO. Changes in ventilator support while on ECMO, even to the point of extubation, are also occurring. This article will review briefly some of the literature related to criteria for severity of illness before ECMO and related to ECMO care and practice. Issues relating to the use of ECMO as a resuscitative tool in cardiac arrest as well as the controversial topic of volume and outcome will also be presented.

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Pathogen screening and prognostic factors in children with severe ARDS of pulmonary origin

Phung

Suzuki

Phan

et al. 2017

Pediatric Pulmonology

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BackgroundAcute respiratory distress syndrome (ARDS) is one of the most lethal diseases encountered in the pediatric intensive care unit (PICU). The etiological pathogens and prognostic factors of severe ARDS of pulmonary origin in children with respiratory virus infections were prospectively investigated.MethodsEnrolled children fulfilled the following criteria: (1) PICU admission; (2) age of 1 month to 16 years; (3) diagnosis of infectious pneumonia and respiratory virus infection; and (4) development of severe ARDS within 72 h after PICU admission. Pathogens were detected in the blood and tracheal lavage fluid using molecular techniques and a conventional culture system. The serum levels of inflammatory mediators on the day of PICU admission were examined.ResultsFifty‐seven patients (32 boys; median age, 9 months) were enrolled. Multiple virus infections, co‐infection with bacteria/fungus, and bacteremia/fungemia were observed in 60%, 49%, and 32% of children, respectively. Adenovirus‐B, measles virus, and cytomegalovirus were detected predominantly in tracheal lavage fluid. There were no statistically significant differences between non‐survivors and survivors regarding the types of pathogen, incidence of multiple virus infection, gender, age, clinical features, and treatment. The serum levels of interferon (IFN)‐γ and the IFN‐γ/interleukin (IL)‐10 ratio were higher in non‐survivors.ConclusionsIFN‐γ upregulation as detected on the day of PICU admission was found to be one of the possible prognostic factors affecting a fatal outcome. These results suggest that modulation of inflammatory responses is critical for the clinical management of children with ARDS.

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Characterizing Degree of Lung Injury in Pediatric Acute Respiratory Distress Syndrome

Cited by 100 publications

References 34 publications

Identifying an Oxygenation Index Threshold for Increased Mortality in Acute Respiratory Failure

Identifying an Oxygenation Index Threshold for Increased Mortality in Acute Respiratory Failure

Year in Review 2015: Extracorporeal Membrane Oxygenation

Pathogen screening and prognostic factors in children with severe ARDS of pulmonary origin

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