Clinical Profile and Outcome of Moderate to Severe Acute Respiratory Distress Syndrome in a Paediatric Intensive Care Unit of Eastern India: A Prospective Cohort Study
Introduction: Paediatric Acute Respiratory Distress Syndrome (PARDS) remains a major cause of mortality and morbidity in Paediatric Intensive Care Units (PICU) despite various advanced management strategies. The management and outcome of PARDS depend on the severity of the disease. Aim: To study th...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2024-04-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://www.jcdr.net/articles/PDF/19244/67340_CE[Ra1]_F(IS)_QC_REF_PAT(AN_IS)_PF1(AKA_SS)_PFA(AKA_KM)_PN(KM).pdf |
| Summary: | Introduction: Paediatric Acute Respiratory Distress Syndrome (PARDS) remains a major cause of mortality and morbidity in Paediatric Intensive Care Units (PICU) despite various advanced management strategies. The management and outcome of PARDS depend on the severity of the disease.
Aim: To study the clinical profile in terms of aetiology and outcome of paediatric patients with moderate to severe Acute Respiratory Distress Syndrome (ARDS) in the PICU.
Materials and Methods: A prospective cohort study was conducted at the PICU in Dr. BC Roy Postgraduate Institute of Paediatric Sciences, Kolkata, West Bengal, India, from July 2018 to June 2019. A total of 120 children aged between two months and 12 years who developed moderate to severe ARDS according to Paediatric Acute Lung Injury Consensus Conference (PALICC) criteria were included. Demographic details, different risk factors, morbidity patterns, and outcomes were recorded. Patients were categorised into three groups based on Positive End Expiratory Pressure (PEEP): 5-8 cm of H2O, 9-12 cm of H2O, and >12 cm of H2O. Based on Peak Inspiratory Pressure (PIP), patients were divided into two groups: <30 cm of H2O and 30-35 cm of H2O. Data were statistically analysed using the Chi-square test, Fisher’s test, and t-tests where applicable.
Results: Out of a total of 120 children with moderate to severe ARDS, there were 75 males and 45 females. Direct lung injury accounted for 79 cases (65.5%), while indirect lung injury occurred in 41 cases (34.5%). Pneumonia and sepsis were the most common causes of direct and indirect lung injury, respectively. Among 75 cases of pneumonia, 40 deaths were reported (53.3%), and out of 37 cases of sepsis, 31 resulted in death (83%). On the day of admission, 38.3% of cases were classified as moderate ARDS and 61.7% as severe ARDS. The mortality rate for severe ARDS was 77%, compared to 43.5% for moderate ARDS. The mortality rate was 100% in the PEEP max >12 cm of H2O group and 84.4% in the PIP 30-35 cm of H2O group.
Conclusion: The majority of ARDS cases are due to direct lung injury caused by pneumonia, and the outcome is better than in cases of indirect lung injury. Mortality is nearly twice as high in severe ARDS as in moderate ARDS. |
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| ISSN: | 2249-782X 0973-709X |