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. 2020 Sep 25;12(9):e10651.
doi: 10.7759/cureus.10651.

Clinical Course of Pediatric Acute Respiratory Distress Syndrome at Moderate Altitude

María A Chacón  1 , Alejandra Calderon  2 , Jaime Fernández-Sarmiento  3 , Blanca Rios  3
Affiliations

Clinical Course of Pediatric Acute Respiratory Distress Syndrome at Moderate Altitude

María A Chacón et al. Cureus. .

Abstract

Background This is a retrospective case series, and the main objective is to describe the epidemiology, clinical features, and outcomes of pediatric acute respiratory distress syndrome in patients at moderate altitude. Methods Children from the Pediatric Intensive Care Unit (PICU) at the Fundación Cardioinfantil, hospitalized with acute respiratory distress syndrome, were prospectively enrolled from March 2009 to March 2014. We evaluated the demographic data, mechanical ventilation, gas exchange, hemodynamics, and multiorgan dysfunction. Results During the study period, 88 patients met the inclusion criteria. Bronchiolitis and pneumonia were the most common causes of acute respiratory distress syndrome. The overall mortality rate was 19.5%. At the beginning of the study, the average relation between blood pressure and the fraction of inspired oxygen (Pa/Fi) was 130.3 ± 52.2; tidal volume was 7.94 ± 1.7 ml/kg, the plateau pressure 25.3 ± 5.09 cmH2O, and positive end-expiratory pressure was 7.2 ± 3.2 cmH2O. After 24 hours, the mortality rate in the group with severe acute respiratory distress syndrome (Pa/Fi <100) was 46.7%, in the moderate acute respiratory distress syndrome group (Pa/Fi 100-200) it was 11.9%, and finally in the mild acute respiratory distress syndrome group (Pa/Fi 200-300) the mortality was 25%. This study found a relation between serum lactate value and positive end-expiratory pressure and mortality (p = 0.02 and 0.0013). Conclusions This study shows that pediatric acute respiratory distress syndrome patients at moderate altitudes have similar clinical behavior, including mortality rate, to those at low altitudes. However, Pa/Fi is not a good predictor of mortality for patients with mild and moderate acute respiratory distress syndrome.

Keywords: acute respiratory distress syndrome; children; moderate altitude; protective ventilation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Patients flow diagram.
Figure 2
Figure 2. Mortality rate according to ARDS severity at diagnosis (based on the Pa/Fi ratio).
ARDS: Acute Respiratory Distress Syndrome, Pa/Fi: Relation between blood pressure and the fraction of inspired oxygen
Figure 3
Figure 3. Mortality rate according to ARDS severity at 24 hours after diagnosis (based on the Pa/Fi ratio).
ARDS: Acute Respiratory Distress Syndrome, Pa/Fi: Relation between blood pressure and the fraction of inspired oxygen
Figure 4
Figure 4. Mortality (%) and number of organs involved.
See this image and copyright information in PMC

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