Etiological factors and clinical outcomes in acute respiratory distress syndrome in a paediatric intensive care unit

Abstract

Objective: To evaluate the aetiological factors of acute respiratory distress syndrome and their impact on disease severity and outcomes in paediatric intensive care patients.

Method: The cross-sectional study was conducted at the paediatric intensive care unit of The Children’s Hospital, Lahore, Pakistan, from March 2023 to March 2024, and comprised -paediatric patients with acute respiratory distress syndrome diagnosed as per the criteria outlined by the second Paediatric Acute Lung Injury Consensus Conference. The patients were assigned into pulmonary and extrapulmonary groups. Data was obtained through a detailed review of medical records regarding demographics, clinical characteristics, radiological characteristics, oxygenation indices, type of ventilation, exposure to steroids and sepsis. The assessed outcomes were the severity of acute respiratory distress syndrome, survival, ventilation-free days, and the length of paediatric intensive care unit and hospital stay. Data was analysed using SPSS 23.

Results: Of the 90 patients, 49(54.4%) were boys with median age 8.00 years (interquartile range: 2.00-11.00 years) and 41(45.6%) were girls with median age 4.50 years (interquartile range: 3.00-7.00 years). The acute respiratory distress syndrome severity was mild in 31(34.4%) cases, moderate 34(38.9%) and severe 24(26.7%). There was no strong association between disease aetiology and severity. The results were greatly affected by the level of immunosuppression, the type of ventilation and the severity of acute respiratory distress syndrome. With increasing ARDS severity (p< 0.001) survival decreased significantly, survivors had longer PICU stay then non survivors (p< 0.001).

Conclusion: Disease severity and patient-specific factors were the main factors determining clinical outcomes in paediatric acute respiratory distress syndrome independently of aetiology.

Key Words: Respiratory distress syndrome, Non-invasive ventilation, Immunosuppression.