Acute respiratory distress syndrome: A pediatric intensive care unit experience from an eastern Indian state

Abstract

Background: Prevalence of acute respiratory distress syndrome (ARDS) in PICU is high with high mortality, however data from developing country with resource limited ICU are lacking in literature. Objective: To study the sociodemographic characteristics, predisposing conditions, and complications of ARDS in a tertiary care PICU and to compare the different oxygenation and ventilator parameters with survival. Methods: This prospective observational study was conducted in a PICU from a tertiary care centre. All sick children admitted to PICU over a period of 18mo who developed ARDS based on American European consensus conference committee criteria definition were enrolled. The association of survival with demographic, clinical profile, complication, different oxygenation and ventilator parameters were analysed through SPSS 24. Results: Fourty one cases of ARDS were diagnosed with an incidence of19.4 per 1000 ICU admission. Median (IQR) age at presentation was 72(42-120 mo), 30(73.1%) were males and 32(78.0%) from rural area. Sepsis 16(39.0%) and malaria 8(19.5) were the major predisposing condition, whereas shock 34(82.9%) and pneumothorax 31(75.6%) are major complication. Only 5(12%) patients survived. No significant difference in age, sex, place of residence, predisposing factors and other complications were found between survivors and non-survivors (p > 0.05). Non-survivor ARDS had more of non-pulmonary cause (p-0.006) and remained fewer days in ventilator (p-0.010). No significant difference was found in oxygenation (paO2/FiO2), respiratory mechanics and lung injury score between both groups. Conclusion: ARDS is a serious complication in children admitted to ICU with sepsis, malaria and H1N1 with high mortality. ARDS due to non pulmonary causes and ARDS complicated with shock contribute significantly to mortality. Oxygenation (PaO2/FiO2), respiratory mechanics and lung injury score are not significantly better on survivors.