소아에서 급성 호흡곤란증후군의 임상 결과 및 예후: 단일기관 연구 = AARD : ORIGINAL ARTICLE ; Outcome of acute respiratory distress syndrome in children: a single center study

다국어 초록 (Multilingual 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.

참고문헌 (Reference)

1 고정민, "소아 급성 호흡곤란 증후군의 치료 성적 및 예후 인자" 대한소아과학회 48 (48): 599-605, 2005

2 최승준, "다양한 질병의 환자들이 입원하는 소아 중환자실에서 PRISM III의 적용" 대한중환자의학회 26 (26): 123-127, 2011

3 The Acute Respiratory Distress Syndrome Network, "Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome" 342 : 1301-1308, 2000

4 Pollack MM, "The pediatric risk of mortality III: Acute Physiology Score (PRISM III-APS): a method of assessing physiologic instability for pediatric intensive care unit patients" 131 : 575-581, 1997

5 Ware LB, "The acute respiratory distress syndrome" 342 : 1334-1349, 2000

6 Bernard GR, "The American-European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination" 149 (149): 818-824, 1994

7 Arnold JH, "Prospective, randomized comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure" 22 : 1530-1539, 1994

8 Mehta S, "Prospective trial of high-frequency oscillation in adults with acute respiratory distress syndrome" 29 : 1360-1369, 2001

9 Lopez-Fernandez Y, "Pediatric Acute Lung Injury Epidemiology and Natural History study: incidence and outcome of the acute respiratory distress syndrome in children" 40 : 3238-3245, 2012

10 Lachmann B, "Open up the lung and keep the lung open" 18 : 319-321, 1992

11 Goldstein B, "International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics" 6 : 2-8, 2005

12 Headley AS, "Infections and the inflammatory response in acute respiratory distress syndrome" 111 : 1306-1321, 1997

13 Hu X, "Incidence, management and mortality of acute hypoxemic respiratory failure and acute respiratory distress syndrome from a prospective study of Chinese paediatric intensive care network" 99 : 715-721, 2010

14 Dahlem P, "Incidence and short-term outcome of acute lung injury in mechanically ventilated children" 22 : 980-985, 2003

15 Zimmerman JJ, "Incidence and outcomes of pediatric acute lung injury" 124 : 87-95, 2009

16 Arnold JH, "High-frequency oscillatory ventilation in pediatric respiratory failure: a multicenter experience" 28 : 3913-3919, 2000

17 Bernard GR, "High-dose corticosteroids in patients with the adult respiratory distress syndrome" 317 : 1565-1570, 1987

18 Villar J, "From ventilator-induced lung injury to physician-induced lung injury: why the reluctance to use small tidal volumes?" 48 : 267-271, 2004

19 Meduri GU, "Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial" 280 : 159-165, 1998

20 Bone RC, "An early test of survival in patients with the adult respiratory distress syndrome: the PaO2/FIO2 ratio and its differential response to conventional therapy. Prostaglandin E1 Study Group" 96 : 849-851, 1989

21 Kneyber MC, "Acute respiratory distress syndrome: is it underrecognized in the pediatric intensive care unit?" 34 : 751-754, 2008

22 Ashbaugh DG, "Acute respiratory distress in adults" 2 : 319-323, 1967

23 Erickson S, "Acute lung injury in pediatric intensive care in Australia and New Zealand: a prospective, multicenter, observational study" 8 : 317-323, 2007