Epidemiology of Cause of Death in Pediatric Acute Respiratory Distress Syndrome. Crit Care Med 2018 Nov;46(11):1811-1819
Date
08/11/2018Pubmed ID
30095498Pubmed Central ID
PMC6185780DOI
10.1097/CCM.0000000000003371Scopus ID
2-s2.0-85054898345 (requires institutional sign-in at Scopus site) 47 CitationsAbstract
OBJECTIVES: Investigations of acute respiratory distress syndrome in adults suggest hypoxemia is an uncommon cause of death. However, the epidemiology of death in pediatric acute respiratory distress syndrome is not well characterized. We aimed to describe the cause, mode, and timing of death in pediatric acute respiratory distress syndrome nonsurvivors. We hypothesized that most deaths would be due to nonpulmonary factors, rather than hypoxemia.
DESIGN: Retrospective, decedent-only analysis.
SETTING: Two large, academic PICUs.
PATIENTS: Nonsurvivors with pediatric acute respiratory distress syndrome.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Of 798 subjects with pediatric acute respiratory distress syndrome, there were 153 nonsurvivors (19% mortality). Median time to death was 6 days (interquartile range, 3-13 d) after pediatric acute respiratory distress syndrome onset. Patients dying less than 7 days after pediatric acute respiratory distress syndrome onset had greater illness severity and worse oxygenation. Patients dying less than 7 days were more likely to die of a neurologic cause, including brain death. Patients dying greater than or equal to 7 days after pediatric acute respiratory distress syndrome onset were more commonly immunocompromised. Multisystem organ failure predominated in deaths greater than or equal to 7 days. Withdrawal of therapy was the most common mode of death at all timepoints, accounting for 66% of all deaths. Organ dysfunction was common at time of death, irrespective of cause of death. Refractory hypoxemia accounted for only a minority of pediatric acute respiratory distress syndrome deaths (20%).
CONCLUSIONS: In pediatric acute respiratory distress syndrome, early deaths were due primarily to neurologic failure, whereas later deaths were more commonly due to multisystem organ failure. Deaths from neurologic causes accounted for a substantial portion of nonsurvivors. Refractory hypoxemia accounted for only a minority of deaths. Our study highlights limitations associated with using death as an endpoint in therapeutic pediatric acute respiratory distress syndrome trials.
Author List
Dowell JC, Parvathaneni K, Thomas NJ, Khemani RG, Yehya NAuthor
Jasmine C. Dowell MD Associate Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentCause of Death
Child
Child, Preschool
Female
Hospital Mortality
Humans
Intensive Care Units, Pediatric
Male
Organ Dysfunction Scores
Respiration, Artificial
Retrospective Studies
Severity of Illness Index
