Incidence, etiology, sociodemographic and clinical characterization of acute respiratory failure in pediatric patients at a high-altitude city: A multicenter cohort study

Abstract

BackgroundAcute respiratory failure is a life-threatening medical condition, associated with a variety of conditions and risk factors, including acute respiratory diseases which are a frequent cause of pediatric morbidity and mortality worldwide. In Colombia, the literature related to ARF is scarce.ObjectiveTo determine the incidence, causes, and sociodemographic and clinical characteristics of ARF in three hospitals in Bogota, a high-altitude city located in Colombia, during the COVID-19 pandemic.MethodsA multicenter prospective cohort study called the FARA cohort was developed between April 2020 – December 2021. Patients older than one month and younger than 18 years with respiratory distress who developed ARF were included.Results685 patients with respiratory distress were recruited in 21 months. The incidence density of ARF was found to be 41.7 cases per 100 person-day CI 95%, (37.3–47.7). The median age was 4.5 years.. Most of the patients consulted during the first 72 h after the onset of symptoms. Upon admission, 67.2% were potentially unstable. The most frequent pathologies were asthma, bronchiolitis, pneumonia, and sepsis. At admission, 75.6% of the patients required different oxygen delivery systems, 29,5% a low-flow oxygen system, 36,8% a high-flow oxygen system, and 9,28% invasive mechanical ventilation. SARS-COV-2, respiratory syncytial virus, rhinovirus/enterovirus, and adenovirus were the most frequently isolated viral agents. The coinfection cases were scarce.ConclusionsThis multicenter study, the FARA cohort, developed at 2,600 meters above sea level, shows the first data on incidence, etiology, sociodemographic and clinical characterization in a pediatric population with ARF that also concurs with the COVID-19 pandemic. These results, not only have implications for public health but also contribute to the scientific and epidemiological literature on a disease developed at a high altitude.

Use of high‐flow cannula in pediatric patients with respiratory failure: A prospective cohort study in three high‐altitude hospitals

“…Out of the 685 patients with respiratory distress, 66 patients had confirmed SARS‐CoV‐2 infection. 12 , 13 …”

“…Out of the 685 patients with respiratory distress, 66 patients had confirmed SARS-CoV-2 infection. 12,13 Of the total patients who developed ARF (296), 50.3% were male (149) and 49.6% female (147), the majority being under 2 years of age (45.2%), followed by preschoolers (25%), school children (17.9%), and adolescents (11.8%) (see Table 1). The prevalence of HFNC use in ARF in these hospitals was 48.0%.…”

“…Additionally, since the patients who entered the study all had respiratory distress, they all underwent a SARS‐CoV‐2 test, following the guidelines of each hospital. Out of the 685 patients with respiratory distress, 66 patients had confirmed SARS‐CoV‐2 infection 12,13 …”

Burden of respiratory failure in pediatric patients: Analysis of a prospective multicenter cohort in Bogotá, Colombia

“…Before analyzing each of the aspects that make up DALYs, the demographic characteristics that could influence the outcomes of the disease were taken, such as age, sex, socioeconomic status, and the main causes that led to development of respiratory failure and causes of mortality. 22 Additionally, for deaths, comorbidities, prenatal history, and immunization status of patients were recorded. YLL represents death that occurs before reaching maximum life expectancy and measures the length of time lost due to premature mortality.…”

“…In our study, the pathologies that most contribute to the loss of potential years of life were shock secondary to various pathologies (septic, hypovolemic, and cardiac shock) and ARF itself, ARI (bronchiolitis, pneumonia, and croup) being the main cause that led to respiratory failure. 22 It should be considered that 63% of the patients had some comorbidity, and this could influence the life expectancy of these patients. However, this analysis is not part of the objectives of our study.…”