Acute Hypoxemic Respiratory Failure in Children at the Start of COVID-19 Outbreak: A Nationwide Experience.

Yolanda M López-Fernández, ,Patricia Rodríguez-Campoy,Jesús M González-Martín,Rocío Núñez-Borrero,María Miñambres-Rodríguez,Jesús Villar,Julio Parrilla-Parrilla,César Pérez-Caballero Macarrón,Paula Madurga-Revilla,Laura Butragueño-Laiseca,Arthur S Slutsky,Ana Gómez-Zamora,Amelia Martínez-De-Azagra,María García-González,Juan Mayordomo-Colunga,José M González-Gómez

doi:10.3390/jcm10194301

Abstract

Study design: This is a prospective, multicenter, and observational study with the aim of describing physiological characteristics, respiratory management, and outcomes of children with acute hypoxemic respiratory failure (AHRF) from different etiologies receiving invasive mechanical ventilation (IMV) compared with those affected by SARS-CoV-2. Methods and Main Results: Twenty-eight patients met the inclusion criteria: 9 patients with coronavirus disease 2019 (COVID-19) and 19 patients without COVID-19. Non-COVID-19 patients had more pre-existing comorbidities (78.9% vs. 44.4%) than COVID-19 patients. At AHRF onset, non-COVID-19 patients had worse oxygenation (PaO2/FiO2 = 95 mmHg (65.5–133) vs. 150 mmHg (105–220), p = 0.04), oxygenation index = 15.9 (11–28.4) vs. 9.3 (6.7–10.6), p = 0.01), and higher PaCO2 (48 mmHg (46.5–63) vs. 41 mmHg (40–45), p = 0.07, that remained higher at 48 h: 54 mmHg (43–58.7) vs. 41 (38.5–45.5), p = 0.03). In 12 patients (5 COVID-19 and 7 non-COVID-19), AHRF evolved to pediatric acute respiratory distress syndrome (PARDS). All non-COVID-19 patients had severe PARDS, while 3 out of 5 patients in the COVID-19 group had mild or moderate PARDS. Overall Pediatric Intensive Care Medicine (PICU) mortality was 14.3%. Conclusions: Children with AHRF due to SARS-CoV2 infection had fewer comorbidities and better oxygenation than patients with non-COVID-19 AHRF. In this study, progression to severe PARDS was rarely observed in children with COVID-19.

Highlights

The novel coronavirus disease 2019 (COVID-19) has affected the population around the globe
A total of 700 children were admitted to participating PICUs: 373 patients required respiratory support for >24 h
PICU admissions and 15.2% among those on invasive mechanical ventilation (IMV)

Summary

Introduction

The novel coronavirus disease 2019 (COVID-19) has affected the population around the globe. Reports from China focused on adults because initially, children experienced disease with milder symptoms [4,5]. In children was reported from a number of countries Most children with this syndrome had fever, gastrointestinal, mucocutaneus, hematological and respiratory symptoms, and cardiovascular involvement appeared to be responsible for disease severity. Adults with COVID-19 developed acute hypoxemic respiratory failure (AHRF) with an associated high mortality requiring intubation and invasive mechanical ventilation (IMV) [13,14,15]. In children with respiratory failure requiring IMV due to COVID19, overall mortality was considerably lower [4,5,8,9,10,11,12]. There is a paucity of studies comparing children with AHRF associated with COVID-19 versus patients with

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