دورية أكاديمية
أعرض في EDS

A Simple and Robust Bedside Model for Mortality Risk in Pediatric Patients With Acute Respiratory Distress Syndrome.

التفاصيل البيبلوغرافية
العنوان: A Simple and Robust Bedside Model for Mortality Risk in Pediatric Patients With Acute Respiratory Distress Syndrome.
المؤلفون: Spicer AC; 1Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA.2Departments of Anesthesia and Medicine, University of California, San Francisco, CA.3Division of Critical Care, Department of Pediatrics, University of California, Benioff Children's Hospital-San Francisco, San Francisco, CA.4Departments of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA.5Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.6Department of Pediatrics, Children's Hospital of Central California, Fresno, CA.7Department of Pediatrics, University of Wisconsin-Madison, Madison, WI.8Division of Pediatric Critical Care, University of California, San Francisco Benioff Children's Hospital-Oakland, Oakland, CA.9Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA., Calfee CS, Zinter MS, Khemani RG, Lo VP, Alkhouli MF, Orwoll BE, Graciano AL, Boriosi JP, Howard JP, Flori HR, Matthay MA, Sapru A
المصدر: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2016 Oct; Vol. 17 (10), pp. 907-916.
نوع المنشور: Clinical Trial; Journal Article; Multicenter Study
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 100954653 Publication Model: Print Cited Medium: Internet ISSN: 1529-7535 (Print) Linking ISSN: 15297535 NLM ISO Abbreviation: Pediatr Crit Care Med Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Baltimore, MD : Lippincott Williams & Wilkins, c2000-
مواضيع طبية MeSH: Decision Support Techniques* , Point-of-Care Testing*, Respiratory Distress Syndrome/*mortality, Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Intensive Care Units, Pediatric ; Logistic Models ; Male ; Multivariate Analysis ; Prognosis ; Prospective Studies ; Respiratory Distress Syndrome/diagnosis ; Risk Assessment
مستخلص: Objectives: Despite declining mortality, acute respiratory distress syndrome is still involved in up to one third of pediatric intensive care deaths. The recently convened Pediatric Acute Lung Injury Consensus Conference has outlined research priorities for the field, which include the need for accurate bedside risk stratification of patients. We aimed to develop a simple yet robust model of mortality risk among pediatric patients with acute respiratory distress syndrome to facilitate the targeted application of high-risk investigational therapies and stratification for enrollment in clinical trials.
Design: Prospective, multicenter cohort.
Setting: Five academic PICUs.
Patients: Three hundred eight children greater than 1 month and less than or equal to 18 years old, admitted to the ICU, with bilateral infiltrates on chest radiograph and PaO2/FIO2 ratio less than 300 in the clinical absence of left atrial hypertension.
Interventions: None.
Measurements and Main Results: Twenty clinical variables were recorded in the following six categories: demographics, medical history, oxygenation, ventilation, radiographic imaging, and multiple organ dysfunction. Data were measured 0-24 and 48-72 hours after acute respiratory distress syndrome onset (day 1 and 3) and examined for associations with hospital mortality. Among 308 enrolled patients, mortality was 17%. Children with a history of cancer and/or hematopoietic stem cell transplant had higher mortality (47% vs 11%; p < 0.001). Oxygenation index, the PaO2/FIO2 ratio, extrapulmonary organ dysfunction, Pediatric Risk of Mortality-3, and positive cumulative fluid balance were each associated with mortality. Using two statistical approaches, we found that a parsimonious model of mortality risk using only oxygenation index and cancer/hematopoietic stem cell transplant history performed as well as other more complex models that required additional variables.
Conclusions: In the PICU, oxygenation index and cancer/hematopoietic stem cell transplant history can be used on acute respiratory distress syndrome day 1 or day 3 to predict hospital mortality without the need for more complex models. These findings may simplify risk assessment for clinical trials, counseling families, and high-risk interventions such as extracorporeal life support.
Competing Interests: Copyright form disclosures: The remaining authors have disclosed that they do not have any potential conflicts of interest.
التعليقات: Comment in: Pediatr Crit Care Med. 2016 Oct;17(10):998-999. (PMID: 27705984)
References: Crit Care Med. 2012 Oct;40(10):2883-9. (PMID: 22824936)
Pediatr Crit Care Med. 2007 Jul;8(4):317-23. (PMID: 17545931)
Acta Paediatr. 2010 May;99(5):715-21. (PMID: 20096024)
J Biomed Inform. 2009 Apr;42(2):377-81. (PMID: 18929686)
Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):818-24. (PMID: 7509706)
Crit Care Med. 2012 Dec;40(12):3238-45. (PMID: 22990455)
N Engl J Med. 2006 Jun 15;354(24):2564-75. (PMID: 16714767)
Pediatr Crit Care Med. 2015 Jun;16(5):428-39. (PMID: 25647235)
Pediatr Crit Care Med. 2015 Jun;16(5 Suppl 1):S6-22. (PMID: 26035365)
Chest. 2009 Mar;135(3):662-8. (PMID: 19029434)
N Engl J Med. 2010 Sep 16;363(12):1107-16. (PMID: 20843245)
JAMA. 2005 Jul 13;294(2):229-37. (PMID: 16014597)
N Engl J Med. 2013 Jun 6;368(23):2159-68. (PMID: 23688302)
Pediatr Crit Care Med. 2015 Jun;16(5 Suppl 1):S61-72. (PMID: 26035366)
Curr Stem Cell Res Ther. 2012 Sep;7(5):381-7. (PMID: 22834995)
Chin Med J (Engl). 2012 Jul;125(13):2265-71. (PMID: 22882846)
Intensive Care Med. 2010 Jan;36(1):157-63. (PMID: 19855955)
Pediatr Crit Care Med. 2010 Nov;11(6):681-9. (PMID: 20228688)
Pediatr Crit Care Med. 2015 Jun;16(5 Suppl 1):S111-7. (PMID: 26035361)
Crit Care Med. 2015 Sep;43(9):1986-94. (PMID: 26035280)
Pediatr Crit Care Med. 2007 Jul;8(4):324-30. (PMID: 17545937)
N Engl J Med. 2000 May 4;342(18):1301-8. (PMID: 10793162)
Pediatrics. 2009 Jul;124(1):87-95. (PMID: 19564287)
J Pediatr. 1991 Dec;119(6):896-9. (PMID: 1960603)
Pediatr Crit Care Med. 2013 Nov;14(9):851-61. (PMID: 24108118)
Crit Care Med. 2015 Dec;43(12):2660-7. (PMID: 26317570)
Intensive Care Med. 2009 Aug;35(8):1428-37. (PMID: 19533092)
Pediatr Crit Care Med. 2013 Sep;14(7):666-72. (PMID: 23925143)
Crit Care Res Pract. 2011;2011:854142. (PMID: 21687578)
Am J Respir Crit Care Med. 2005 May 1;171(9):995-1001. (PMID: 15618461)
Crit Care Med. 2015 May;43(5):937-46. (PMID: 25746744)
Crit Care Med. 2011 Feb;39(2):364-70. (PMID: 20959787)
Intensive Care Med. 2014 Oct;40(10):1536-44. (PMID: 25023526)
معلومات مُعتمدة: K23 HL085526 United States HL NHLBI NIH HHS; R01 HL114484 United States HL NHLBI NIH HHS; K12 HD000850 United States HD NICHD NIH HHS; T32 HD049303 United States HD NICHD NIH HHS; R01 HL110969 United States HL NHLBI NIH HHS
تواريخ الأحداث: Date Created: 20160805 Date Completed: 20171012 Latest Revision: 20201209
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC5268071
DOI: 10.1097/PCC.0000000000000865
PMID: 27487912
قاعدة البيانات: MEDLINE
الوصف
تدمد:1529-7535
DOI:10.1097/PCC.0000000000000865