소아에서 급성 호흡곤란증후군의 임상 결과 및 예후: 단일기관 연구
Outcome of acute respiratory distress syndrome in children: a single center study
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Purpose: This study aimed to determine the incidence, etiology, prognostic factors, and outcome of acute respiratory distress syndrome (ARDS) in children and to provide epidemiological data of children with ARDS treated at the pediatric intensive care unit (PICU) of a single center in Korea. Methods: We conducted a retrospective medical chart review of 19 children diagnosed with ARDS at the PICU of The Catholic University of Korea, Seoul St. Mary's Hospital, between March 2009 and February 2012. Results: Of the 334 PICU patients, 19 (5.6%) satisfied the American-European Consensus Conference definition of ARDS. Thirteen patients with ARDS died (mortality rate, 68.4%). Pneumonia was the most common cause of ARDS and observed in 10 patients (52.6%). There were significant differences between survivors and nonsurvivors in the PaO₂/FiO₂ ratio and the number of organ failure. The mortality rate was significantly higher in patients with a baseline PaO₂/FiO₂ ratio ≤100 mmHg than in those with a baseline PaO₂/FiO₂ ratio>100 mmHg (84.6% vs. 33.3%, P=0.046). We observed that a higher number of organ failure during the PICU stay, resulted in a higher mortality rate (P=0.037). Multiple logistic regression analysis showed that the PaO₂/FiO₂ ratio (adjusted odds ratio, 0.958) was independently associated with the increased risk of death after controlling for the number of organ failure. Conclusion: The mortality rate of ARDS in children was 68.4% in this study, a higher rate than those reported in other national and international studies. The PaO₂/FiO₂ ratio at the time of ARDS onset was a helpful prognostic factor for predicting the mortality rate of children with ARDS.
Abstract
Purpose: This study aimed to determine the incidence, etiology, prognostic factors, and outcome of acute respiratory distress syndrome (ARDS) in children and to provide epidemiological data of children with ARDS treated at the pediatric intensive care unit (PICU) of a single center in Korea. Methods: We conducted a retrospective medical chart review of 19 children diagnosed with ARDS at the PICU of The Catholic University of Korea, Seoul St. Mary's Hospital, between March 2009 and February 2012. Results: Of the 334 PICU patients, 19 (5.6%) satisfied the American-European Consensus Conference definition of ARDS. Thirteen patients with ARDS died (mortality rate, 68.4%). Pneumonia was the most common cause of ARDS and observed in 10 patients (52.6%). There were significant differences between survivors and nonsurvivors in the PaO₂/FiO₂ ratio and the number of organ failure. The mortality rate was significantly higher in patients with a baseline PaO₂/FiO₂ ratio ≤100 mmHg than in those with a baseline PaO₂/FiO₂ ratio>100 mmHg (84.6% vs. 33.3%, P=0.046). We observed that a higher number of organ failure during the PICU stay, resulted in a higher mortality rate (P=0.037). Multiple logistic regression analysis showed that the PaO₂/FiO₂ ratio (adjusted odds ratio, 0.958) was independently associated with the increased risk of death after controlling for the number of organ failure. Conclusion: The mortality rate of ARDS in children was 68.4% in this study, a higher rate than those reported in other national and international studies. The PaO₂/FiO₂ ratio at the time of ARDS onset was a helpful prognostic factor for predicting the mortality rate of children with ARDS.
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