Year :
2024
| Month :
April
| Volume :
18
| Issue :
4
| Page :
SC06 - SC10
Clinical Profile and Outcome of Moderate to Severe Acute Respiratory Distress Syndrome in a Paediatric Intensive Care Unit of Eastern India: A Prospective Cohort Study
Gobinda Mondal, Manoj Kumar Sahoo, Anjan Kumar Das, Banasree Roy, Asok Kumar Mandal
1. Associate Professor, Department of Paediatrics, Dr. B.C. Roy Postgraduate Institute of Pediatric Sciences, Kolkata, West Bengal, India.
2. Resident, Department of Neonatology, Surya Children Hospital, Mumbai, Maharastra, India.
3. Associate Professor, Department of Paediatrics, Dr. B.C. Roy Postgraduate Institute of Pediatric Sciences, Kolkata, West Bengal, India.
4. Associate Professor, Department of Paediatrics, Deben Mahato Government Medical College & Hospital, Purulia, West Bengal, India.
5. Professor & Head, Department of Paediatrics, Dr. B.C. Roy Postgraduate Institute of Pediatric Sciences, Kolkata, West Bengal, India.
Correspondence Address :
Banasree Roy,
19/C/3, Abinash Chandra Banerjee Lane, Kolkata-700010, West Bengal, India.
E-mail: drbr1978@rediffmail.com
Abstract
Introduction: Paediatric Acute Respiratory Distress Syndrome (PARDS) remains a major cause of mortality and morbidity in Paediatric Intensive Care Units (PICU) despite various advanced management strategies. The management and outcome of PARDS depend on the severity of the disease.
Aim: To study the clinical profile in terms of aetiology and outcome of paediatric patients with moderate to severe Acute Respiratory Distress Syndrome (ARDS) in the PICU.
Materials and Methods: A prospective cohort study was conducted at the PICU in Dr. BC Roy Postgraduate Institute of Paediatric Sciences, Kolkata, West Bengal, India, from July 2018 to June 2019. A total of 120 children aged between two months and 12 years who developed moderate to severe ARDS according to Paediatric Acute Lung Injury Consensus Conference (PALICC) criteria were included. Demographic details, different risk factors, morbidity patterns, and outcomes were recorded. Patients were categorised into three groups based on Positive End Expiratory Pressure (PEEP): 5-8 cm of H2O, 9-12 cm of H2O, and >12 cm of H2O. Based on Peak Inspiratory Pressure (PIP), patients were divided into two groups: <30 cm of H2O and 30-35 cm of H2O. Data were statistically analysed using the Chi-square test, Fisher’s test, and t-tests where applicable.
Results: Out of a total of 120 children with moderate to severe ARDS, there were 75 males and 45 females. Direct lung injury accounted for 79 cases (65.5%), while indirect lung injury occurred in 41 cases (34.5%). Pneumonia and sepsis were the most common causes of direct and indirect lung injury, respectively. Among 75 cases of pneumonia, 40 deaths were reported (53.3%), and out of 37 cases of sepsis, 31 resulted in death (83%). On the day of admission, 38.3% of cases were classified as moderate ARDS and 61.7% as severe ARDS. The mortality rate for severe ARDS was 77%, compared to 43.5% for moderate ARDS. The mortality rate was 100% in the PEEP max >12 cm of H2O group and 84.4% in the PIP 30-35 cm of H2O group.
Conclusion: The majority of ARDS cases are due to direct lung injury caused by pneumonia, and the outcome is better than in cases of indirect lung injury. Mortality is nearly twice as high in severe ARDS as in moderate ARDS.
Keywords
Direct lung injury, Hypoxemia, Pneumonia, Sepsis
DOI and Others
DOI: 10.7860/JCDR/2024/67340.19244
Date of Submission: Sep 02, 2023
Date of Peer Review: Nov 14, 2023
Date of Acceptance: Jan 29, 2024
Date of Publishing: Apr 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 05, 2023
• Manual Googling: Nov 17, 2023
• iThenticate Software: Jan 25, 2024 (7%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
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