Sepsis-related pediatric acute respiratory distress syndrome: A multicenter prospective cohort study
Pharsai Prasertsan, Nattachai Anantasit1, Suchanuch Walanchapruk2, Koonkoaw Roekworachai3, Rujipat Samransamruajkit4, Jarin Vaewpanich2
Department of Pediatrics, Division of Pediatric Pulmonology and Critical Care Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
1Department of Pediatrics, Division of Pediatric Critical Care, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
2Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
3Department of Pediatrics, Nakornping Hospital, Chiang Mai, Thailand
4Department of Pediatrics, Division of Pediatric Critical Care, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Keywords: Organ dysfunction, outcomes, pediatric, pediatric acute respiratory distress syndrome, risk factors, sepsis
OBJECTIVES: This study aimed to compare the risk factors and outcomes for organ dysfunction between sepsis related Pediatric acute respiratory distress syndrome (PARDS) and nonsepsis PARDS.
METHODS: We prospective cohort recruited intubated patients with PARDS at four tertiary care centers in Thailand. The baseline characteristics, mechanical ventilation, fluid balance, and clinical outcomes were collected. The primary outcome was organ dysfunction.
RESULTS: One hundred and thirty two mechanically ventilated children with PARDS were included in the study. The median age was 29 months and 53.8% were male. The mortality rate was 22.7% and organ dysfunction was 45.4%. There were 26 (19.7%) and 106 (80.3%) patients who were classified into sepsis related PARDS and nonsepsis PARDS, respectively. Sepsis related PARDS patients had a significantly higher incidence of acute kidney injury (30.8% vs. 13.2%, P = 0.041), septic shock (88.5% vs. 32.1%, P < 0.001), organ dysfunction (84.6% vs. 35.8%, P < 0.001), and death (42.3% vs. 17.9%, P = 0.016) than nonsepsis PARDS group. Multivariate analysis adjusted for clinical variables showed that sepsis related PARDS and percentage of fluid overload were significantly associated with organ dysfunction (odds ratio [OR] 11.414; 95% confidence interval [CI] 1.40892.557, P = 0.023 and OR 1.169; 95% CI 1.0121.352, P = 0.034).
CONCLUSIONS: Sepsis related PARDS patients had more severe illness, organ dysfunction, and mortality than nonsepsis PARDS patients. The higher percentage of fluid overload and presentation of sepsis was the independent risk factor of organ dysfunction in PARDS patients.
How to cite this article: Prasertsan P, Anantasit N, Walanchapruk S, Roekworachai K, Samransamruajkit R, Vaewpanich J. Sepsis-related pediatric acute respiratory distress syndrome: A multicenter prospective cohort study. Turk J Emerg Med 2023;23:96-103.
We obtained ethical approval from the Ethical Approval from the institutional review board. The IRB numbers were COA. MURA2017/14 (Committee on Human Rights Related to Research Involving Human Subjects, Faculty of Medicine Ramathibodi Hospital, Mahidol University) date of approval January 18, 2017, REC 60‑077‑19‑1 (Investigational Review Board and Ethic Committee of the Faculty of Medicine, Prince of Songkla University) date of approval 15 March 2017, EMID: 0e1a497022346ec5 (Research and journal Management Committee Nakornping Hospital) date of approval November 7, 2017, IRB 1642/2559 (Med Chula IRB) date of approval December 5, 2016.
Written informed consents obtained from the legal guardians of the children.
PP and SW contributed to the design of the study, data collection, data analysis and manuscript drafting. KR, RS, and JV contributed to data collection. NA contributed to the design of the study, data collection, data analysis, and critically revised it for important intellectual content. All authors gave final approval of the version to be published.
The authors would like to acknowledge the Department of Pediatrics, Ramathibodi Hospital, Mahidol University that allowed us to analyze this project. We would like to thank Mr. Stephen Pinder, a native‑speaking medical English specialist for conducting a comprehensive English language review. Furthermore, our special thanks to all participants who were recruited into this study.