Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 May 1;26(5):e600-e610.
doi: 10.1097/PCC.0000000000003712. Epub 2025 Mar 6.

Acute Respiratory Distress Syndrome in Children With Lower Respiratory Tract Infection Requiring Invasive Mechanical Ventilation: Post Hoc Analysis of the 2019-2020 Bronchiolitis and Codetection Cohort

Benjamin R White  1 , Lee Polikoff  2 , Robin Alexander  3 , Benjamin R Baer  4 , Alexandre T Rotta  5 , Sebastián González-Dambrauskas  6   7 , Ledys M Izquierdo  6   8 , Pablo Castellani  6   9 , Christopher M Watson  10 , Ryan A Nofziger  11 , Steven Pon  12 , Todd Karsies  13 , Steven L Shein  14 ; with the Bronchiolitis And COdetectioN (BACON) Study Investigators; for the Bronchiolitis Subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators Network and the Red Colaborativa Pediátrica de Latinoamérica Network
Collaborators, Affiliations
Observational Study

Acute Respiratory Distress Syndrome in Children With Lower Respiratory Tract Infection Requiring Invasive Mechanical Ventilation: Post Hoc Analysis of the 2019-2020 Bronchiolitis and Codetection Cohort

Benjamin R White et al. Pediatr Crit Care Med. .

Abstract

Objectives: Bronchiolitis and other lower respiratory tract infections (LRTIs) are the most common causes of pediatric respiratory failure. There is insufficient evidence characterizing pediatric acute respiratory distress syndrome (PARDS) in young children with LRTI to inform clinical management. We aimed to describe the prevalence and clinical characteristics of children intubated for LRTI and meeting PARDS criteria.

Design: We performed a post hoc analysis of data from the Bronchiolitis And COdetectioN (BACON) study, an international prospective observational study of critical bronchiolitis. We compared PARDS subjects (meeting criteria the first full calendar day following intubation) to non-PARDS subjects.

Setting: Forty-eight international PICUs recruiting to the BACON study, from December 2019 to November 2020.

Patients: Children younger than 2 years old, requiring mechanical ventilation for acute LRTI.

Interventions: None.

Measurements and main results: Complete data were available for 571 children. Day 1 PARDS was diagnosed in 240 subjects(42%) and associated with increased mortality (7.9% vs. 2.7%; p = 0.023), greater duration of invasive ventilation (165 hr [interquartile range, 112-251 hr] vs. 135 hr [76-204 hr]; p < 0.001), and PICU length of stay (11 d [7-16 d] vs. 8 d [5-13 d]; p < 0.001). In our multivariable competing risk model, the presence of PARDS on day 1 was causally related to a prolonged duration of mechanical ventilation with the probability of extubation at 7 days for those with PARDS equal to 49% (44-54%) compared with 64% (59-69%) for those without PARDS.

Conclusions: PARDS development was common in this critical bronchiolitis cohort, resulted in a longer duration of mechanical ventilation, and was associated with increased mortality and PICU length of stay. Prospective studies are needed to elucidate the optimal management of critical bronchiolitis.

Keywords: acute respiratory distress syndrome; bronchiolitis; critical care; mechanical ventilator; pediatric.

PubMed Disclaimer

Conflict of interest statement

Dr. Polikoff received funding from Novavax. Dr. Rotta received funding from Breas US and Elsevier. Dr. Nofziger’s institution received funding from the Centers for Disease Control and Prevention and the National Institutes of Health. Dr. Shein received funding from Ceribell. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. Li Y, Wang X, Blau DM, et al.; Respiratory Virus Global Epidemiology Network: Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: A systematic analysis. Lancet. 2022; 399:2047–2064
    1. Fujiogi M, Goto T, Yasunaga H, et al.: Trends in bronchiolitis hospitalizations in the United States: 2000-2016. Pediatrics. 2019; 144:e20192614
    1. Slain KN, Malay S, Shein SL: Hospital charges associated with critical bronchiolitis from 2009 to 2019. Pediatr Crit Care Med. 2022; 23:171–180
    1. Cruces P, González-Dambrauskas S, Quilodrán J, et al.: Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation. BMC Pulm Med. 2017; 17:129
    1. Polack FP, Stein RT, Custovic A: The syndrome we agreed to call bronchiolitis. J Infect Dis. 2019; 220:184–186

Publication types

MeSH terms

LinkOut - more resources