Post-discharge respiratory outcomes of children with acute respiratory distress syndrome
Post-discharge respiratory outcomes of children with acute respiratory distress syndrome
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DOI：
10.1002/ppul.24581
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发表时间：
2019-11-25
影响因子：
3.1
通讯作者：
Tse, Sze Man
中科院分区：
文献类型：
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作者：
Boucher, Valerie;Mathy, Clemence;Tse, Sze Man
虽然急性呼吸窘迫综合征（ARDS）的长期后遗症在成人中有充分的文献记载，但很少有研究报道儿科ARDS （PARDS）的出院后呼吸并发症，也没有研究使用最近的儿科急性肺损伤共识会议（PALICC）的诊断标准。本研究描述了出院后3个月PARDS幸存者的呼吸症状、肺功能和卫生资源使用情况。设计回顾性研究。患者选择：2015年9月1日至2017年7月1日在圣贾斯汀大学卫生中心重症监护室住院的未满18岁的儿童，符合PALICC PARDS诊断标准。方法对44例PARDS患儿中的38例在出院后平均（SD） 3.4（2.0）个月的随访临床中进行呼吸症状、与年龄相适应的肺功能测试（肺活量测定或波动测量、最大呼吸压力）、出院后的全因急诊（ED）就诊或再住院情况的评估。结果有14例（36.8%）患儿出现呼吸道异常症状（多见于呼吸道感染与喘息之间的咳嗽），其中7例（18.4%）患儿在PARDS诊断后出现新的呼吸道症状。在进行肺活量测定的10例患者中，有3例观察到轻度至中度的限制模式，在进行这些操作的8例患者中，有2例观察到最大吸气压力轻度降低。9例（23.7%）患者就诊于急诊科，4例（10.5%）患者出院后再次住院。结论：尽管我们的队列样本量有限，但我们的研究结果表明，相当一部分PARDS幸存者经历了异常呼吸症状、肺功能缺陷和复发性问题，需要就医。需要更大的、多中心的研究来确定与PARDS幸存者出院后预后不良相关的危险因素。
Objectives While long-term sequelae of acute respiratory distress syndrome (ARDS) are well-documented in adults, few studies reported post-discharge respiratory complications in pediatric ARDS (PARDS) and none used the recent Pediatric Acute Lung Injury Consensus Conference (PALICC) diagnostic criteria. This study describes the respiratory symptoms, pulmonary function, and health resource use of PARDS survivors at 3 months post-discharge. Design Retrospective study. Patient Selection Children less than 18 years admitted to the intensive care unit of Sainte-Justine University Health Center from 1st September 2015 to 1st July 2017, and meeting PALICC diagnostic criteria for PARDS. Methods We evaluated 38 of the 44 children with PARDS in the follow-up clinic at a mean (SD) of 3.4 (2.0) months post-discharge for respiratory symptoms, age-appropriate pulmonary function tests (spirometry or oscillometry, maximal respiratory pressures), and all-cause emergency department (ED) visits or rehospitalizations since discharge. Results Fourteen (36.8%) had abnormal respiratory symptoms (most commonly cough between respiratory infections and wheezing), 7 of whom (18.4%) presented new respiratory symptoms since PARDS diagnosis. A mild-to-moderate restrictive pattern was observed in 3 of 10 patients who performed spirometry and mildly decreased maximal inspiratory pressures were noted in 2 of 8 patients who performed these maneuvers. Nine (23.7%) patients consulted in the ED and 4 (10.5%) were rehospitalized post-discharge. Conclusions Despite our cohort's limited sample size, our findings suggest that a significant proportion of PARDS survivors experience abnormal respiratory symptoms, pulmonary function deficits, and recurrent problems requiring medical attention. Larger, multicenter studies are required to identify risk factors associated with poor post-discharge outcomes among PARDS survivors.