Prognostic relevance and inter-observer reliability of chest-imaging in pediatric ARDS: a pediatric acute respiratory distress incidence and epidemiology (PARDIE) study
Prognostic relevance and inter-observer reliability of chest-imaging in pediatric ARDS: a pediatric acute respiratory distress incidence and epidemiology (PARDIE) study
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DOI：
10.1007/s00134-020-06074-7
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发表时间：
2020-05-25
影响因子：
38.9
通讯作者：
Khemani, Robinder G.
中科院分区：
文献类型：
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作者：
Lopez-Fernandez, Yolanda M.;Smith, Lincoln S.;Khemani, Robinder G.
目的急性呼吸窘迫综合征（ARDS）的定义包括放射学标准，但存在可靠性和预后相关性的担忧。本研究旨在评估胸部成像与死亡率之间的独立关系，并检查儿童ARDS （PARDS）胸片（CXR）解释的内部变异性。方法前瞻性、国际观察性研究，在符合儿科急性肺损伤共识会议（PALICC） PARDS标准的儿童中进行，该标准要求新的浸润符合肺实质疾病，而不要求双侧浸润。死亡率分析侧重于整个队列，而观察者间变异性使用的是由重症医师和放射科医生同时盲传cxr的患者子集。结果通过对708例PARDS患者的cxr分析，双侧浸润和肺泡实变的四个象限与死亡率在单变量基础上相关。对于使用有创通气（IMV）或无创通气（NIV）且PaO2/FiO(2) （PF）比率(或SpO(2)/FiO（2) （SF）比率相当）为bbb100的患者，双侧浸润（or为1.3 (95% CI 0.68, 2.5), p = 0.43）和4象限肺泡实变（or为1.6 (0.85,3),p = 0.14）均与死亡率无关。对于10年PF患者（kappa 0.43），体液平衡> 40 ml/kg （kappa 0.48）。结论双侧浸润和肺泡实变象限仅与PF比值相关
Purpose Definitions of acute respiratory distress syndrome (ARDS) include radiographic criteria, but there are concerns about reliability and prognostic relevance. This study aimed to evaluate the independent relationship between chest imaging and mortality and examine the inter-rater variability of interpretations of chest radiographs (CXR) in pediatric ARDS (PARDS). Methods Prospective, international observational study in children meeting Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria for PARDS, which requires new infiltrate(s) consistent with pulmonary parenchymal disease, without mandating bilateral infiltrates. Mortality analysis focused on the entire cohort, whereas inter-observer variability used a subset of patients with blinded, simultaneous interpretation of CXRs by intensivists and radiologists. Results Bilateral infiltrates and four quadrants of alveolar consolidation were associated with mortality on a univariable basis, using CXRs from 708 patients with PARDS. For patients on either invasive (IMV) or non-invasive ventilation (NIV) with PaO2/FiO(2) (PF) ratios (or SpO(2)/FiO(2) (SF) ratio equivalent) > 100, neither bilateral infiltrates (OR 1.3 (95% CI 0.68, 2.5), p = 0.43), nor 4 quadrants of alveolar consolidation (OR 1.6 (0.85, 3), p = 0.14) were associated with mortality. For patients with PF 10 years (kappa 0.43) and fluid balance > 40 ml/kg (kappa 0.48). Conclusion Bilateral infiltrates and quadrants of alveolar consolidation are associated with mortality only for those with PF ratio