학술논문

Immunocompromised-Associated Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study*
Document Type
Academic Journal
Author
Gertz, Shira J.Bhalla, AnoopindarChima, Ranjit S.Emeriaud, GuillaumeFitzgerald, Julie C.Hsing, Deyin D.Jeyapalan, Asumthia S.Pike, FrancisSallee, Colin J.Thomas, Neal J.Yehya, NadirRowan, Courtney M.Sforza, JesicaPoterala, RossanaFernandez, AnaliaAvila Vera, AntonioOrqueda, DanielAgueda Vidal, NildaRosemary, DehezaTuron, GonzaloMonjes, CeciliaFernando Espanol, SegundoSiaba Serrate, AlejandroIolster, ThomasTorres, SilvioCinquegrani, KarinaJose Montes, MariaCapocasa, PatriciaFerreyra, MarcelaCastellani, PabloGiampieri, MartinPedraza, ClaudiaMartin Landry, LuisAlthabe, MariaVanesa Fortini, YaninaBotta, PriscilaPaziencia, FernandoErickson, SimonBarr, SamanthaShea, SaraButt, WarwickDelzoppo, CarmelPintimalla, AlyssaMartinez Leon, Alejandro FabioGuzman Rivera, Gustavo AlfredoJouvet, PhilippeEmeriaud, GuillaumeDumitrascu, MarianaEllen French, MaryCaro, DanielCastillo, IAndres, E.Cruces Romero, PabloMedina, TaniaPavez Madrid, PaulaCortez, AmbarAlvear, JimenaAcuna, CarlosDiaz, FrancoJose Nunez, MariaWegner Araya, AdrianaGodoy Mundaca, LoretoChen, YangPerez Lozano, GermanPardo Carrero, RosalbaLopez Alarcon, Yurika PaolaMazzillo Vega, LilianaMaria Izquierdo, LedysPiñeres Olave, Byron EnriqueZuluaga Orrego, CesarQuinonez Lopez, DeyaniraVasquez Hoyos, PabloVavrina, MartinZurek, JiriCampos-Miño, SantiagoYerovi, RocioBridier, ArmellePayen, ValerieMilesi, ChristopheBourgoin, PierreTravert, BrendanGenuini, MathieuStarck, JulieMaria, MatthieuGuichoux, JulieBaudin, FlorentBriassoulis, GeorgeIlia, StavroulaDi Nardo, MatteoCamporesi, AnnaChiusolo, FabrizioShime, NobuakiOhshimo, ShinichiroKida, YoshikoKyo, MichihitoTabata, YuichiFong Tang, SweeWern Tai, ChianSee Lum, Lucy ChaiElghuwael, IsmailJimenez Rivera, Nestor JavierJarillo Quijada, Alberto EKneyber, MartinDijkstra, SandraBeca, JohnSherring, ClaireMiriam, ReaVargas G, Sonia IVasquez Miranda, DanielRamirez Cortez, GrimaldoTantalean, JosePagowska-Klimek, IzabelaGil Escobar, CarlosSousa Moniz, MartaCamilo, CristinaHazwani, TarekAldairi, NedaaAl Amoudi, AhmedAlahmadti, AhmadTaylor, RyanMendizabal, MikelGoni Orayen, ConcepcionLopez Fernandez, YolandaRamon Valle, JuanMartinez, LidiaPilar Orive, JavierBrezmes, MartaLopez-Herce, JesusParrilla, JulioGaboli, MirellaGonzalez Gomez, Jose ManuelMorales Martinez, AntonioAlapont, Vicent Modesto ISanchez Diaz, Juan IgnacioLlorente de la Fuente, Ana M.Palanca Arias, DanielMadurga Revilla, PaulaMartinez de Azagra, AmeliaGarcia Gonzalez, MariaArjona Villanueva, DavidGarcia Casas, PaulaBrio Sanagustin, SoniaPons Odena, MartiMedina, AlbertoOnate Vergara, EiderRodriguez Campoy, PatriciaReyes Dominguez, SusanaDursun, OguzAtike Ongun, EbruKamit Can, FulyaBerna Anil, AyseBaines, PaulWalsh, LauraJones, DawnSadasivam, KalaimaranMildner, ReinoutPlunkett, AdrianLillie, JonTibby, ShaneWellman, PaulBelfield, HollyBrierley, JoeDominguez, Troy E.Abaleke, EugeniaFeinstein, YaelDeep, AkashSundararajan, SantoshOruganti, SivaSilvestre, CatarinaWeitz, JamesSheward, VictoriaMacrae, DuncanAramburo, AngelaFortune, Peter-MarcSubramanian, GayathriJennings, ClaireDwarakanathan, BuvanaInwald, DavidFeather, CalandraAgbeko, RachelLawton-Woodhall, AngelaMcIntyre, KarenSykes, KimPappachan, JonGale, HelenMellish, ChristieMcCorkell, JenniTorero, LuisNofziger, RyanLatifi, SamirAnthony, HeatherSanders, RonHefley, GlendaVirk, ManpreetJaimon, NancyMaddux, Aline B.Mourani, Peter M.Ralston, KimberlySierra, YamilaKhemani, RobinderNewth, ChristopherBhalla, AnoopindarKwok, JeniMorzov, RicaMahapatra, SidharthTruemper, EdwardKustka, LucindaNett, Sholeen T.Singleton, MarcyDean Jarvis, J.Yehya, NadirNapolitano, NatalieMurphy, MarieRonan, LaurieMorgan, RyanKubis, SherriBroden, ElizabethWillson, DouglasHenderson, GraceGedeit, RainerMurkowski, KathyWoods, KatherineKasch, MaryHan, Yong YAffolter, Jeremy TTieves, Kelly SHughes-Schalk, AmberChima, Ranjit S.Krallman, KelliStoneman, ErinBenken, LauraYunger, ToniSchneider, JamesSweberg, ToddKessel, AaronCarroll, Christopher L.Santanelli, JamesAckerman, Kate GCullimore, MelissaRowan, CourtneyBales, MelissaKeith Dockery, W.Jafari-Namin, ShirinBarry, DanaJane’t, KearyAlibrahim, OmarPatankar, NikhilQiao, HaipingGertz, ShiraSu, FeliceHaileselassie, BereketeabSong, HanqiuBysani, KrisMonjure, TraceyBeltramo, FernandoTotapally, BalagangadharGovantes, BeatrizCoates, BriaWellisch, LawrenAllen, KionaShukla, AvaniThomas, Neal J.Spear, DebbieShein, Steven L.Gertz, ShiraParker, Margaret M.Sloniewsky, DanielAllen, ChristineHarrell, AmyPinto, NeethiKniola, AllisonRodgers, ChiaraCvijanovich, NatalieTyppo, KatriKelley, ConnorKing, CarolineSapru, AnilRatiu, AnnaAshtari, NedaSikora, LindsayJeyapalan, Asumthia S.Coronado-Munoz, AlvaroFlori, HeidiDahmer, Mary K.Jayachandran, ChaandiniHume, JanetNerheim, DanSmith, RebeccaSpaeder, MichaelAdu-Darko, MichelleSmith, LincolnHartmann, SilviaSullivan, ErinMerritt, CourtneyAl-Subu, AwniBlom, AndreaLin, John C.Spinella, PhilipHsing, Deyin D.Pon, SteveBrian Estil, JimGautam, RichaGiuliano, John S., Jr; Tala, Joana
Source
Pediatric Critical Care Medicine. Apr 01, 2024 25(4):288-300
Subject
Language
English
ISSN
1529-7535
Abstract
OBJECTIVES:: To characterize immunocompromised-associated pediatric acute respiratory distress syndrome (I-PARDS) and contrast it to PARDS. DESIGN:: This is a secondary analysis of the 2016–2017 PARDS incidence and epidemiology (PARDIE) study, a prospective observational, cross-sectional study of children with PARDS. SETTING:: Dataset of 145 PICUs across 27 countries. PATIENTS:: During 10 nonconsecutive weeks (from May 2016 to June 2017), data about immunocompromising conditions (ICCs, defined as malignancy, congenital/acquired immunodeficiency, posttransplantation, or diseases requiring immunosuppression) were collected. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Of 708 subjects, 105 (14.8%) had ICC. Before the development of I-PARDS, those with ICC were more likely to be hospitalized (70% vs. 35%, p < 0.001), have more at-risk for PARDS (p = 0.046), and spent more hours at-risk (20 [interquartile range, IQR: 8–46] vs. 11 [IQR: 4–33], [p = 0.002]). Noninvasive ventilation (NIV) use was more common in those with ICC (p < 0.001). Of those diagnosed with PARDS on NIV (n = 161), children with ICC were more likely to be subsequently intubated (n = 28/40 [70%] vs n = 53/121 [44%], p = 0.004). Severe PARDS was more common (32% vs 23%, p < 0.001) in I-PARDS. Oxygenation indices were higher at diagnosis and had less improvement over the first 3 days of PARDS (p < 0.001). Children with I-PARDS had greater nonpulmonary organ dysfunction. Adjusting for Pediatric Risk of Mortality IV and oxygenation index, children with I-PARDS had a higher severity of illness-adjusted PICU mortality (adjusted hazard ratio: 3.0 [95% CI, 1.9–4.7] p < 0.001) and were less likely to be extubated alive within 28 days (subdistribution hazard ratio: 0.47 [95% CI, 0.31–0.71] p < 0.001). CONCLUSIONS:: I-PARDS is a unique subtype of PARDS associated with hospitalization before diagnosis and increased: time at-risk for PARDS, NIV use, hypoxia, nonpulmonary organ dysfunction, and mortality. The opportunity for early detection and intervention seems to exist. Dedicated study in these patients is imperative to determine if targeted interventions will benefit these unique patients with the ultimate goal of improving outcomes.