Pediatric acute lung injury - Prospective evaluation of risk factors associated with mortality
Pediatric acute lung injury - Prospective evaluation of risk factors associated with mortality
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DOI：
10.1164/rccm.200404-544oc
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发表时间：
2005-05-01
影响因子：
24.7
通讯作者：
Matthay, MA
中科院分区：
文献类型：
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作者：
Flori, HR;Glidden, DV;Matthay, MA
理由：1994年美欧共识委员会对急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）的定义尚未系统地应用于儿科人群。目的：本研究的目的是采用共识标准，前瞻性评估两个大型儿科重症监护室收治的所有ALI/ARDS患儿死亡和延长机械通气时间相关的流行病学和临床危险因素。方法：前瞻性地识别所有符合共识委员会对ALI定义的儿科患者，并将其纳入关系数据库。测量和主要结果：ALI/ARDS入院328例，死亡率22%。多因素logistic回归分析显示：(1)初始氧合缺陷严重程度，以Pa-o2/Fl（o2）比值衡量；(2)存在非肺和非中枢神经系统（CNS）器官功能障碍；(3)中枢神经系统功能障碍与死亡率和延长机械通气时间独立相关。相当一部分患者（28%）在ALI发病时不需要机械通气；这些患者中有46%最终因ALI恶化而需要插管。结论：小儿ALI/ARDS死亡率高，几个危险因素具有重要的预后价值。与成人的ards相比，儿童动脉低氧血症的初始严重程度与死亡率密切相关。很大一部分儿童ALI/ARDS患者可以在需要气管插管之前被识别出来。这些患者提供了一个有价值的群体，可以在他们身上测试新的治疗方法。
Rationale: The 1994 American European Consensus Committee definitions of acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) have not been applied systematically in the pediatric population. Objectives: The purpose of this study was to evaluate prospectively the epidemiology and clinical risk factors associated with death and prolonged mechanical ventilation in all pediatric patients admitted to two large, pediatric intensive care units with ALI/ARDS using Consensus criteria. Methods: All pediatric patients meeting Consensus Committee definitions for ALI were prospectively identified and included in a relational database. Measurements and Main Results: There were 328 admissions for ALI/ARDS with a mortality of 22%. Multivariate logistic regression analyses revealed (1) the initial severity of oxygenation defect, as measured by the Pa-o2/Fl(o2) ratio; (2) the presence of nonpulmonary and non-central nervous system (CNS) organ dysfunction; and (3) the presence of CNS dysfunction were independently associated with mortality and prolonged mechanical ventilation. A substantial fraction of patients (28%) did not require mechanical ventilation at the onset of ALI; 46% of these patients eventually required intubation for worsening ALI. Conclusions: Mortality in pediatric ALI/ARDS is high and several risk factors have major prognostic value. In contrast to AWARDS in adults, the initial severity of arterial hypoxemia in children correlates well with mortality. A significant fraction of patients with pediatric ALI/ARDS can be identified before endotracheal intubation is required. These patients provide a valuable group in whom new therapies can be tested.