Morbidity and Mortality Among Critically Injured Children With Acute Respiratory Distress Syndrome.
Morbidity and Mortality Among Critically Injured Children With Acute Respiratory Distress Syndrome.
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DOI：
10.1097/ccm.0000000000003525
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发表时间：
2019-03
影响因子：
8.8
通讯作者：
Rivara FP
中科院分区：
文献类型：
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作者：
Killien EY;Mills B;Watson RS;Vavilala MS;Rivara FP
为了评估患有急性呼吸窘迫综合征(ARDS)的危重受伤儿童的发病率和死亡率，回顾队列研究460个I/II级成人或儿科创伤中心对国家创伤数据库146,058名患者的贡献&从2007-2016年间在重症监护室收治的146,058名创伤患者没有评估有和没有ARDS患者的住院死亡率和出院后护理需求，以及幸存者的医院资源利用和出院处置。分析调整了潜在的死亡风险(年龄、损伤严重程度评分、严重脑或胸部损伤、入院时心率和低血压)、年份、转移状态和设施创伤级别指定。发生ARDS 2590例(1.8%)。ARDS患者的死亡率为20.0%，非ARDS患者为4.3%，调整后的相对危险度(ARR)为1.76(95%可信区间为1.52-2.04)。44.8%的ARDS患者需要出院后护理，而非ARDS患者的出院后护理需求为16.0%(ARR3.59，2.87-4.49)，只有351%的ARDS患者出院回家，而非ARDS患者的出院后护理需求为79.8%。在十年的研究期间，ARDS死亡率没有变化(ARR 1.01/年，0.96-1.06)，需要出院后护理的ARDS患者的比例也没有变化(ARR 1.04/年，0.97-1.11)。ARDS幸存者的呼吸机持续时间、ICU住院时间和住院时间均显著延长。ARDS幸存者中18.4%的患者行气管切开术，而非ARDS患者为2.1%(ARR3.10，2.59-3.70)。儿童创伤后发生ARDS与发病率和死亡率显著增加有关，即使在调整了损伤严重程度和血流动力学异常后也是如此。在过去十年中，结果没有改善，强调需要对严重受伤儿童中的ARDS采取新的治疗干预措施和预防战略。
To evaluate morbidity and mortality among critically injured children with acute respiratory distress syndrome (ARDS) Retrospective cohort study 460 Level I/II adult or pediatric trauma centers contributing to the National Trauma Data Bank 146,058 patients <18 years admitted to an intensive care unit with traumatic injury from 2007–2016 None We assessed in-hospital mortality and need for post-discharge care among patients with and without ARDS, and hospital resource utilization and discharge disposition among survivors. Analyses were adjusted for underlying mortality risk (age, Injury Severity Score, serious brain or chest injury, and admission heart rate and hypotension), and year, transfer status, and facility trauma level designation. ARDS occurred in 2590 patients (1.8%). Mortality was 20.0% among ARDS patients versus 4.3% among non-ARDS patients, with an adjusted relative risk (aRR) of 1.76 (95% CI 1.52–2.04). Post-discharge care was required in an additional 44.8% of ARDS patients versus 16.0% of non-ARDS patients (aRR 3.59, 2.87–4.49), with only 35.1% of ARDS patients discharging to home versus 79.8% of non-ARDS patients. ARDS mortality did not change over the ten-year study period (aRR 1.01/year, 0.96–1.06), nor did the proportion of ARDS patients requiring post-discharge care (aRR 1.04/year, 0.97–1.11). Duration of ventilation, ICU stay, and hospital stay were all significantly longer among ARDS survivors. Tracheostomy placement occurred in 18.4% of ARDS survivors versus 2.1% of non-ARDS patients (aRR 3.10, 2.59–3.70). ARDS development following traumatic injury in children is associated with significantly increased risk of morbidity and mortality, even after adjustment for injury severity and hemodynamic abnormalities. Outcomes have not improved over the past decade, emphasizing the need for new therapeutic interventions and prevention strategies for ARDS among severely injured children.