| Abstract |
Introduction: PARDS (Pediatric Acute Respiratory Syndrome) is one of the leading causes of morbidity and mortality in pediatric ICUs worldwide, with its incidence in hospitalized children reaching 3.2%. It is defined as acute lung injury that leads to respiratory failure and occurs suddenly after a trigger. Until 2014, the definition of adult ARDS of Berlin was used in children, although there have been studies that suggest updating the pediatric criteriamuch earlier, due to the syndrome's differentiatedpathophysiology in children. During the PALICC conference, the definition of pediatric ARDS, and suggestions for intervention and treatment in children were attempted. Based on the definition of the syndrome, the importance of radiological findings in the diagnosis of PARDS and the need for early diagnosisare emphasized. A literature review highlights the lack of studies investigating imaging scoring systems and their potential prognostic significance in childrenwith PARDS and in children ‘at risk of ARDS’. Purpose:To investigate possible associations between radiological findings, clinical, laboratory findings and prognostic indexes in children with PARDS and ‘at risk of ARDS’ admitted in PICU. To evaluate and compare three radiographic scoring systems separately for children with ARDS and children “at risk of ARDS” with regard to clinical, laboratory findings and outcome.
Methodology: This is a single-centered retrospective studyand was performed by review of the files of hospitalized children in the ICU of University Hospital of Heraklion. Laboratory and demographic data, and mechanical ventilation parameters were collected on three separate consecutivedays of hospitalization: for children who developed ARDS these included admission day (D1), day of criteria for ARDS (ARDS development) and worst PICU day (WD). For children΄at risk of ARDS’ these included for children who developed ARDS these included admission day (D1), day of criteria for “at risk of” ARDS and worst PICU day (WD).Chest X-rays of the same days were retrieved, digitized and scored, where available. Radiographic findings were scored utilizing three separate scoring systems: a general one called PICU score, utilized for respiratory failure regardless of aetiology, a relatively general one based on the CT score by Ischikado et al (ARDS score) and a RALE score, utilized in adults with ARDS. CT scans were looked for. All data were statistically correlated with SPSS26.0. Length of PICU stay, duration of mechanical ventilation, oxygenation indices and radiographic scores were independently investigatedfor the presence of ARDS using logistic regression analysis. P<0.05 was considered statistically significant.
Results: During 2009-2019700 mechanically ventilated children were hospitalized in Pediatric ICU.50 children were enrolled in the study aged 5.6 ± 5.1, 26 patients had ARDS (52%), 20 were ‘at risk of ARDS’ (40%) and 4 children progressed from “at risk” to ARDS (8%) (p=0.007).A total of 80 radiographs were studied, out of which 43 had been performed at admission day, 12at the day compatible with ARDS or “at risk of ARDS” and 25 at worst PICU day. Six (12%) CT scans were performed.
Length of PICU stay and duration of mechanical ventilation were positively associated with RALE score at admission day (p=0.0029 and p=0.027, respectively). RALE score of worst PICU day was positively associated with clinical severity indices PELOD (p=0.004) and PRISM (p=0.026).
Oxygenation Saturation Index (OSI) ratio on admission day (D1) and PEEP values on worst PICU day were independently associated with the presence of ARDS (all p<0.001).When comparing clinical and laboratory findings between the ARDS group, the 'at risk' group and the group that evolved to ARDS, statistically significant differences were found, in particular, patients with ARDS had younger age (p=0.007), higher clinical severity (p = 0.003), higher OSI and OI (p <0.001), and longer duration of PICU length of stay (p = 0.017). The duration of mechanical ventilation was higher in the 'at risk' group that evolved into ARDS (p = 0.002) compared to other groups. Linear regression analysis revealed that RALE score at D1 was independently associated with mechanical ventilation days (p = 0.027), and RALE score at WD was independently associated with clinical severity upon admission (PELOD) (p=0.012).
Conclusions: Children with ARDS are significantly younger compared to children at risk of ARDS, exhibit more severe clinical and laboratory findings and longer duration of mechanical ventilation and length of stay in PICU. Out of the three different radiographic scores, it was the RALE score that exhibited significant relations with clinical indices and outcome and might be used as a tool for prognosis.
|
Η συμβολή της απεικόνισης στο παιδιατρικό ARDS
