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Observational Study
. 2025 Jun 1;26(6):e759-e772.
doi: 10.1097/PCC.0000000000003743. Epub 2025 Apr 25.

The Prevalence and Outcome of Acute Hypoxemic Respiratory Failure (PANDORA) Study in Mechanically Ventilated Children: Prospective Multicenter Epidemiology in Spain, 2019-2021

Yolanda M López-Fernández  1 , Amelia Martínez-de-Azagra  2 , Susana B Reyes-Domínguez  3 , Ana Gómez-Zamora  4 , Laura Herrera-Castillo  5 , Ana Coca-Pérez  6 , Julio Parrilla-Parrilla  7 , Alberto Medina  8 , Juan P García-Iñiguez  9 , Marta Brezmes-Raposo  10 , Alexandra Hernández-Yuste  11 , Ana M Llorente de la Fuente  12 , Ignacio Ibarra de la Rosa  13 , José S León-González  14 , Javier Trastoy-Quintela  15 , David Arjona-Villanueva  16 , Jesús M González-Martín  17   18 , Tamas Szakmany  19 , Jesús Villar  17   20   21   22 ; Prevalence AND Outcome of acute hypoxemic Respiratory fAilure in children (PANDORA-CHILD) Network
Collaborators, Affiliations
Observational Study

The Prevalence and Outcome of Acute Hypoxemic Respiratory Failure (PANDORA) Study in Mechanically Ventilated Children: Prospective Multicenter Epidemiology in Spain, 2019-2021

Yolanda M López-Fernández et al. Pediatr Crit Care Med. .

Abstract

Objectives: To describe the epidemiology and outcome of children with acute hypoxemic respiratory failure (AHRF) and/or pediatric acute respiratory distress syndrome (PARDS).

Design: Prospective, observational study in six nonconsecutive 2-month blocks form October 2019 to September 2021.

Setting: A network of 22 PICUs in Spain.

Patients: Consecutive children (7 d to 15 yr old) with a diagnosis of AHRF, defined by Pa o2 /F io2 ratio less than or equal to 300 mm Hg, who needed invasive mechanical ventilation (IMV) using positive end-expiratory pressure (PEEP) greater than or equal to 5 cm H 2 O and F io2 greater than or equal to 0.3.

Interventions: None.

Measurements and main results: The primary outcomes were AHRF prevalence and PICU mortality. The secondary outcomes were the prevalence of IMV with PARDS (IMV-PARDS) and the use of adjunctive therapies. There were 6545 PICU admissions: 1374 (21%) underwent IMV and 181 (2.8%) had AHRF. Ninety-one patients (1.4% of PICU admissions, 6.6% of IMV cases, and 50.3% of AHRF cases) met the Second Pediatric Acute Lung Injury Consensus Conference IMV-PARDS criteria. At baseline, mean (± sd ) tidal volume was 7.4 ± 1.8 mL/kg ideal body weight, PEEP 8.4 ± 3.1 cm H 2 O, F io2 0.68 ± 0.23, and plateau pressure 25.7 ± 6.3 cm H 2 O. Unlike patients with PARDS, adjunctive therapies were used infrequently in non-PARDS AHRF patients. AHRF patients without PARDS had more ventilator-free days than PARDS patients (16.4 ± 9.4 vs. 11.2 ± 10.5; p = 0.002). All-cause PICU mortality in AHRF cases was higher in PARDS vs. non-PARDS patients (30.8% [95% CI, 21.5-41.3] vs. (14.4% [95% CI, 7.9-23.4]; p = 0.01).

Conclusions: In our 2019-2021 PICU population, the prevalence of AHRF is 2.8% of IMV cases. Of such patients, the prevalence of PARDS was 50.3%, and there was a 30.8% mortality, which was higher than in cases of AHRF without PARDS.

Trial registration: ClinicalTrials.gov NCT04791501.

Keywords: acute hypoxemic respiratory failure; acute respiratory distress syndrome; children; epidemiology; lung-protective ventilation.

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Conflict of interest statement

Dr. López-Fernández received a grant from Instituto de Salud Carlos III, Madrid, Spain (PI19/00141). Dr. Villar received grants from Instituto de Salud Carlos III, Madrid, Spain (No. CB06/06/1088, PI19/00141, AC_212/00039), ERA PerMed (JTC_2021), The European Regional Development Funds, Fundación Canaria Instituto de Investigación Sanitaria de Canarias, Spain, and Asociación Científica Pulmón y Ventilación Mecánica, Spain. Dr. Gómez-Zamora received funding from AEROGEN(R). Dr. Szakmany has disclosed that he is Trustee of the Intensive Care National Audit and Research Centre (United Kingdom) Congress Co-Chair 2024 Society of Critical Care Medicine Congress. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

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