Characterizing Degree of Lung Injury in Pediatric Acute Respiratory Distress Syndrome
Characterizing Degree of Lung Injury in Pediatric Acute Respiratory Distress Syndrome
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DOI：
10.1097/ccm.0000000000000867
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发表时间：
2015-05-01
影响因子：
8.8
通讯作者：
Thomas, Neal J.
中科院分区：
文献类型：
--
作者：
Yehya, Nadir;Servaes, Sabah;Thomas, Neal J.
Objective: Although all definitions of acute respiratory distress syndrome use some measure of hypoxemia, neither the Berlin definition nor recently proposed pediatric-specific definitions proposed by the Pediatric Acute Lung Injury Consensus Conference utilizing oxygenation index specify which Pao(2)/Fio(2) or oxygenation index best categorizes lung injury. We aimed to identify variables associated with mortality and ventilator-free days at 28 days in a large cohort of children with acute respiratory distress syndrome.Design: Prospective, observational, single-center study.Setting: Tertiary care, university-affiliated PICU.Patients: Two-hundred eighty-three invasively ventilated children with the Berlin-defined acute respiratory distress syndrome.Interventions: None.Measurements and Main Results: Between July 1, 2011, and June 30, 2014, 283 children had acute respiratory distress syndrome with 37 deaths (13%) at the Children's Hospital of Philadelphia. Neither initial Pao(2)/Fo(2) nor oxygenation index at time of meeting acute respiratory distress syndrome criteria discriminated mortality. However, 24 hours after, both Pao(2)/Fio(2) and oxygenation index discriminated mortality (area under receiver operating characteristic curve, 0.68 [0.59-0.77] and 0.66 [0.57-0.75]; p < 0.001). Pao(2)/Fio(2) at 24 hours categorized severity of lung injury, with increasing mortality rates of 5% (Pao(2)/Fio(2), > 300), 8% (Pao(2)/Fio(2), 201-300), 18% (Pao(2)/Fio(2), 101-200), and 37% (Pao(2)/Fio(2),
