Immunocompromised-Associated Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study.
Immunocompromised-Associated Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study.
复制标题
免疫功能低下相关的小儿急性呼吸窘迫综合征：2016/2017 年小儿急性呼吸窘迫综合征发病率和流行病学前瞻性队列研究的经验。
DOI：
10.1097/pcc.0000000000003421
复制
发表时间：
2024
期刊：
影响因子：
--
通讯作者：
PediatricAcuteRespiratoryDistressSyn
中科院分区：
文献类型：
--
作者：
Gertz,ShiraJ;Bhalla,Anoopindar;Chima,RanjitS;Emeriaud,Guillaume;Fitzgerald,JulieC;Hsing,DeyinD;Jeyapalan,AsumthiaS;Pike,Francis;Sallee,ColinJ;Thomas,NealJ;Yehya,Nadir;Rowan,CourtneyM;PediatricAcuteRespiratoryDistressSyn
目的：描述免疫功能低下相关的小儿急性呼吸窘迫综合征（I-PARDS），并将其与PARDS进行对比。设计：这是2016-2017年PARDS发病率和流行病学（PARDIE）研究的二次分析，PARDIE研究是一项针对PARDS儿童的前瞻性观察性横断面研究。设置：27个国家的145个PICU的数据集。患者：在10个非连续周（2016年5月至2017年6月）期间，收集了有关免疫功能低下疾病（ICC，定义为恶性肿瘤、先天性/获得性免疫缺陷、移植后或需要免疫抑制的疾病）的数据。干预：无。测量和主要结果：708名受试者中，105名（14.8%）患有ICC。在发生I-PARDS之前，ICC患者更有可能住院（70% vs. 35%，p< 0.001），PARDS风险更高（p= 0.046），风险时间更长（20 [四分位数范围，IQR：8-46] vs. 11 [IQR：4-33]，[p= 0.002]）。无创通气（NIV）在ICC患者中更常见（p< 0.001）。在NIV诊断为PARDS的患者中（n= 161），ICC儿童更有可能随后插管（n= 28/40 [70%] vs n= 53/121 [44%]，p= 0.004）。I-PARDS中重度PARDS更常见（32% vs 23%，p< 0.001）。诊断时氧合指数较高，在PARDS的前3天改善较少（p< 0.001）。I-PARDS患儿非肺器官功能障碍更严重。校正儿科死亡风险IV和氧合指数后，I-PARDS儿童的疾病严重程度校正PICU死亡率较高（校正的风险比：3.0 [95% CI，1.9-4.7] p< 0.001），并且在28天内存活拔管的可能性较小结论：I-PARDS是PARDS的一种独特亚型，与诊断前住院相关，并增加了PARDS的风险时间、NIV使用、缺氧、非肺器官功能障碍和死亡率。早期发现和干预的机会似乎是存在的。在这些患者中进行专门的研究是必要的，以确定有针对性的干预措施是否会使这些独特的患者受益，最终目标是改善结果。
OBJECTIVES:To characterize immunocompromised-associated pediatric acute respiratory distress syndrome (I-PARDS) and contrast it to PARDS.DESIGN:This is a secondary analysis of the 2016–2017 PARDS incidence and epidemiology (PARDIE) study, a prospective observational, cross-sectional study of children with PARDS.SETTING:Dataset of 145 PICUs across 27 countries.PATIENTS:During 10 nonconsecutive weeks (from May 2016 to June 2017), data about immunocompromising conditions (ICCs, defined as malignancy, congenital/acquired immunodeficiency, posttransplantation, or diseases requiring immunosuppression) were collected.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:Of 708 subjects, 105 (14.8%) had ICC. Before the development of I-PARDS, those with ICC were more likely to be hospitalized (70% vs. 35%, p< 0.001), have more at-risk for PARDS (p= 0.046), and spent more hours at-risk (20 [interquartile range, IQR: 8–46] vs. 11 [IQR: 4–33],[p= 0.002]). Noninvasive ventilation (NIV) use was more common in those with ICC (p< 0.001). Of those diagnosed with PARDS on NIV (n= 161), children with ICC were more likely to be subsequently intubated (n= 28/40 [70%] vs n= 53/121 [44%], p= 0.004). Severe PARDS was more common (32% vs 23%, p< 0.001) in I-PARDS. Oxygenation indices were higher at diagnosis and had less improvement over the first 3 days of PARDS (p< 0.001). Children with I-PARDS had greater nonpulmonary organ dysfunction. Adjusting for Pediatric Risk of Mortality IV and oxygenation index, children with I-PARDS had a higher severity of illness-adjusted PICU mortality (adjusted hazard ratio: 3.0 [95% CI, 1.9–4.7] p< 0.001) and were less likely to be extubated alive within 28 days (subdistribution hazard ratio: 0.47 [95% CI, 0.31–0.71] p< 0.001).CONCLUSIONS:I-PARDS is a unique subtype of PARDS associated with hospitalization before diagnosis and increased: time at-risk for PARDS, NIV use, hypoxia, nonpulmonary organ dysfunction, and mortality. The opportunity for early detection and intervention seems to exist. Dedicated study in these patients is imperative to determine if targeted interventions will benefit these unique patients with the ultimate goal of improving outcomes.