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01-01-2009 | Pediatric Original

The epidemiology of acute respiratory distress syndrome in pediatric intensive care units in China

Authors: Wen-Liang Yu, Zhu-Jin Lu, Ying Wang, Li-Ping Shi, Feng-Wu Kuang, Su-Yun Qian, Qi-Yi Zeng, Min-Hui Xie, Guo-Ying Zhang, De-Yi Zhuang, Xun-Mei Fan, Bo Sun, Collaborative Study Group of Pediatric Respiratory Failure

Published in: Intensive Care Medicine | Issue 1/2009

Abstract

Objective

To assess the incidence of, predisposing factors for, and the rates and relative risks of mortality from acute respiratory distress syndrome (ARDS) in pediatric patients.

Design

A prospective study in 12 consecutive months from 2004 to 2005 in 25 pediatric intensive care units (PICUs).

Patients and setting

ARDS was diagnosed according to the 1994 American–European Consensus Conference definitions, applied to all severely ill admissions between 1 month and 14 years of age. The PICUs were in major municipalities and provincial cities, and half were university affiliated.

Measurements and results

From a total of 12,018 admissions, 7,269 were severely ill. One hundred and five (1.44%) patients developed ARDS and 64 (61.0%) died, which accounts for 13.2%, of the total ICU death (n = 485, 6.7%) or a nine times relative risk of dying. The median age at onset of ARDS was 24 months and 40% were less than 12 month old. Median time from PICU admission to the onset of ARDS was 16 h, and in 63% <24 h. Pneumonia (55.2%) and sepsis (22.9%) were the major predisposing factors for ARDS. These were respectively 14 and 5 times as high a death rate as those of the severely ill patients without ARDS.

Conclusions

ARDS has a high mortality in these Chinese PICUs, especially in those with pneumonia and sepsis, and adequate management including lung protective ventilation strategy is required.

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Trachsel D, McCrindle BW, Nakagawa S, Bohn D (2005) Oxygenation index predicts outcome in children with acute hypoxemic respiratory failure. Am J Respir Crit Care Med 172:206–211PubMedCrossRef

Dahlem P, Van Aalderen WM, Hamaker ME, Dijkgaal MGW, Bos AP (2003) Incidence and short-term outcome of acute lung injury in mechanically ventilated children. Eur Respir J 22:980–985PubMedCrossRef

Flori HR, Glidden DV, Rutherford GW, Matthay MA (2005) Pediatric acute lung injury. Prospective evaluation of risk factors associated with mortality. Am J Respir Crit Care Med 171:995–1001PubMedCrossRef

Bindl L, Dresbach K, Lentze MJ (2005) Incidence of acute respiratory distress syndrome in German children and adolescents: a population-based study. Crit Care Med 33:209–212PubMedCrossRef

Lu Y, Song Z, Zhou X, Huang S, Zhu D, Yang X, Bai C, Sun B, Spragg R, Shanghai ARDS Study Group (2004) A 12-month clinical survey of incidence and outcome of acute respiratory distress syndrome in Shanghai intensive care units. Intensive Care Med 30:2197–2203PubMedCrossRef

Lu ZJ, Wang Y, Tang DH, Mi YQ, Sun B, Shanghai Pediatric ARDS Study Group (2003) A survey of acute respiratory distress syndrome in four pediatric intensive care units in 2001. Chin J Pediatr 41:619–620

Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg RG (1994) The American–European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824PubMed

American College of Critical Care Medicine of the Society of Critical Care Medicine, American Academy of Pediatrics (1999) Guidelines for developing admission and discharge policies for pediatric intensive care unit. Crit Care Med 27:843–845CrossRef

Moss M, Thompson BT (2002) Definitions and clinical risk factors. In: Matthay MA (ed) Acute respiratory distress syndrome. Marcel Dekker, New York, pp 7–36

10.

Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Steven M, Vincent JL, Ramsay G for the International Sepsis Definitions Conference (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 31:1250–1256PubMedCrossRef

11.

Proulx F, Fayon M, Farrell CA, Lacroix J, Cauthier M (1996) Epidemiology of sepsis and multiple organ dysfunction syndrome in children. Chest 109:1033–1037PubMedCrossRef

12.

Kühl PG, Appel R, Lasch P, Moller J, Bindl L (1996) Ergebnisse einer Umfrage in deutschen Kinderklinken und gemeinsame Empfehlungen der “Arbeitsgemeinschaft ARDS im Kindesalter” zur Beatmungstherapie. Monatschr Kindrheilkd 144:1110–1116

13.

Costil J, Cloup M, Leclerc F, Devictor D, Beaufils F, Simeonl U, Berthier JC, Berner M, Teyssier G, Rosselot JM, Ensel P, Frappat P, Lefrancois C, Roze JC (1995) Acute respiratory distress syndrome (ARDS) in children: Multicenter collaborative study of French group of pediatric intensive care. Pediatr Pulmonol Suppl 11:106–107PubMedCrossRef

14.

Goh AYT, Chan PWK, Lum LCS, Roziah M (1998) Incidence of acute respiratory distress syndrome: a comparison of two definitions. Arch Dis Child 79:256–259PubMedCrossRef

15.

Norrashidah AW, Azizi BH, Zulfiqar MA (1999) Acute respiratory distress syndrome in a paediatric intensive care unit. Med J Malaysia 54:225–229PubMed

16.

Erickson S, Schibler A, Numa A, Nuthall G, Yung M, Pascoe E, Wilkins B on behalf of the Paediatric Study Group; Australian and New Zealand Intensive Care Society (2007) Acute lung injury in pediatric intensive care in Australia and New Zealand—a prospective, multicenter, observational study. Pediatr Crit Care Med 8:317–323

17.

Farias JA, Frutos F, Esteban A, Flores JC, Retta A, Baltodano A, Alía I, Hatzis T, Olazarri F, Petros A, Johnson M (2004) What is the daily practice of mechanical ventilation in pediatric intensive care units? A multicenter study. Intensive Care Med 30:918–925PubMedCrossRef

18.

Brochard L, Roudot-Thoraval F, Roupie E, Delcaux C, Chastre J, Fernandez-Mondejar E, Clementi E, Mancebo J, Factor P, Mataris M, Ranieri M, Blanch L, Rodi G, Mentec H, Dryfuss D, Ferrer M, Brun-Buisson C, Tobin M, LeMaire F, Multicenter Trial Group on Tidal Volume Reduction in ARDS (1998) Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. Am J Respir Crit Care Med 158:1831–1838PubMed

19.

The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1306CrossRef

20.

Ferguson ND, Kacmarek RM, Chiche JD, Singh JM, Hallett DC, Mehta S, Stewart TE (2004) Screening of ARDS patients using standardized ventilator settings: influence on enrollment in a clinical trial. Intensive Care Med 30:1111–1116PubMedCrossRef

21.

Bindl L, Buderus S, Dahlem P, Demirakca S, Goldner M, Huth R, Kohl M, Krause M, Kuhl P, Lasch P, Lewandowski K, Merz U, Moeller J, Mohamad Y, Peters M, Porz W, Vierzig A, Ruchard J, Scharf J, Varnholt V (2003) Gender-based differences in children with sepsis and ARDS: the ESPNIC ARDS Database Group. Intensive Care Med 29:1770–1773PubMedCrossRef

22.

Willson DF, Thomas NJ, Markovitz BP, Bauman LA, DiCarlo JV, Pon S, Jacobs BR, Jeffeson LS, Conaway MR, Egan EA for the Pediatric Acute Lung Injury and Sepsis Investigators Network (2005) Effect of exogenous surfactant (Calfactant) in pediatric acute lung injury: a randomized clinical trial. JAMA 293:470–476

23.

Moller JC, Schaible T, Roll C, Schiffmann J-H, Bindl L, Schrod L, Reiss I, Kohl M, Demirakca S, Hentschel R, Paul T, Vierzig A, Groneck P, von Seefeld H, Schumacher H, Gortner L, The Surfactant ARDS Study Group (2003) Treatment with bovine surfactant in severe acute respiratory distress syndrome in children: a randomized multicenter study. Intensive Care Med 29:437–446PubMed

24.

Ream RS, Hauver JF, Lynch RE, Kountzman B, Gale GB, Mink RB (1999) Low-dose inhaled nitric oxide improves the oxygenation and ventilation of infants and children with acute, hypoxemic respiratory failure. Crit Care Med 29:989–996CrossRef

25.

Dobyns EL, Cornfield DN, Anas NG, Fortenberry JD, Tasker RC, Lynch A, Liu P, Eells PL, Griebel J, Baier M, Kinsella JP, Abman SH (1999) Multicenter randomized controlled trial of the effects of inhaled nitric oxide therapy on gas exchange in children with acute hypoxemic respiratory failure. J Pediatr 134:406–412PubMedCrossRef

26.

Dobyns EL, Anas NG, Fortenberry JD, Deshpande J, Cornfield DN, Tasker RC, Liu P, Eells PL, Griebel J, Kinsella JP, Abman SH (2002) Interactive effects of high-frequency oscillatory ventilation and inhaled nitric oxide in acute hypoxemic respiratory failure in pediatrics. Crit Care Med 30:2425–2429PubMedCrossRef

27.

Paret G, Ziv T, Augarten A, Barzilai A, Ben-Abraham R, Manisterski Y, Barzilay Z (1999) Acute respiratory distress syndrome in children: a 10 years experience. Isr Med Assoc J 1:149–153PubMed

28.

Vieillard-Baron A, Rabiller A, Chergui K, Peyrouset O, Page B, Beauchet A, Jardin F (2005) Prone position improves mechanics and alveolar ventilation in acute respiratory distress syndrome. Intensive Care Med 31:220–226PubMedCrossRef

29.

Martinez M, Diaz E, Joseph D, Villagrá A, Mas A, Fernandez R, Blanch L (1999) Improvement in oxygenation by prone position and nitric oxide in patients with acute respiratory distress syndrome. Intensive Care Med 25:29–36PubMedCrossRef

30.

David M, Karmrodt J, Weiler N, Scholz A, Markstaller K, Eberle B (2005) High-frequency oscillatory ventilation in adults with traumatic brain injury and acute respiratory distress syndrome. Acta Anaesthesiol Scand 49:209–214PubMedCrossRef

31.

Macintosh I, Butt WW, Robertson CF, Best D, Shekerdemian LS (2005) Extending the limits of extracorporeal membrane oxygenation: lung rest for a child with non-specific interstitial pneumonia. Intensive Care Med 31:993–996PubMedCrossRef

Title: The epidemiology of acute respiratory distress syndrome in pediatric intensive care units in China
Authors: Wen-Liang Yu
Zhu-Jin Lu
Ying Wang
Li-Ping Shi
Feng-Wu Kuang
Su-Yun Qian
Qi-Yi Zeng
Min-Hui Xie
Guo-Ying Zhang
De-Yi Zhuang
Xun-Mei Fan
Bo Sun
Collaborative Study Group of Pediatric Respiratory Failure
Publication date: 01-01-2009
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 1/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1254-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The epidemiology of acute respiratory distress syndrome in pediatric intensive care units in China

Abstract

Objective

Design

Patients and setting

Measurements and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Patients and setting

Measurements and results

Conclusions

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