Acute Respiratory Distress Syndrome in Children: 5-Year Study in Srinagarind Hospital

1. ACUTE RESPIRATORY DISTRESS SYNDROME IN CHILDREN IN SRINAGARIND HOSPITAL: A 5 YEAR RETROSPECTIVE STUDY Amnuayporn Apiraksakorn1, MD Jamaree Teeratakulpisarn1, MD Jiraporn Srinakarin2, MD Department of Pediatrics1 and Radiology2,Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

2. Acute Respiratory Distress Syndrome(ARDS) A severe form of acute respiratory failure associated with a high mortality rate in children

3. Pathophysiology of ARDS Protein rich edema fluid

4. Diagnostic criteria The 1994 American European Concensus Conference (AECC) criteria • Acute onset • PaO2/FiO2 ratio < 200 • Bilateral, infiltrates on chest radiograph • Pulmonary-artery wedge pressure ≤ 18 mmHg or absent of clinical evidence of left atrial hypertension • The AECC on ARDS. Am J Respir Crit Care Med 1994; 149: 818-24.

5. Literature review Erickson S et al. Acute lung injury in pediatric intensive care in Australia and New Zealand.Pediatr Crit Care Med 2007; 8: 317-23.

6. Objectives To assess • incidence • predisposing factors • mechanical ventilatory settings • outcomes • complications • mortality

7. Methods Retrospective descriptive study Approved by The Khon Kaen University Ethics Committee For Human Research All charts of ARDS admitted to Pediatric Intensive Care Unit (PICU), Srinagarind Hospital, Thailand, from 2004 to 2008 were reviewed

8. Inclusion criteria 1. All pediatric patients age 1 month to 16 years admitted to PICU in Srinagarind Hospitalduring 1 January 2004 to 31 December 2008 2. Diagnosed with ARDS according to AECC criteria(reviewed CXR by radiologist)

9. Exclusion criteria • cyanotic congenital heart diseases • chronichypoxemic lung diseases • unavailable or incomplete medical records

10. Results J80: ARDS 34 cases Unavailable medical record 1 case No CXR 1 case No bilateral infiltrates on CXR7 cases Not admitted in PICU 2 cases Total ARDS 23 cases

11. ARDS in PICU cases Year

12. Results 23 cases met AECC criteria for ARDS Male : female = 1 : 1.6 average age 7.4 years (0.9 - 15.8 years) The incidence 2.2% of PICU admissions The incidence 0.2% of all hospitalized children The major predisposing factors: pneumonia, sepsis

13. Most cases (22/23) on PCV, one case on HFOV, maximum settings: PIP 24 - 50 cmH2O, PEEP 6 - 14 cmH2O, FiO2 0.8 - 1.0 The mortality rate: 82.6% 8.0% PICU mortality 7.1% all hospitalized pediatric mortality Causes of death: sepsis (52%) severe pneumonia(42%)

14. Underlying diseases in ARDS

15. Maximum ventilatory settings of non-survived patients

16. Non-survived patients(cont.)

17. Survived patients

18. Complications in ARDS

19. Factors associated with mortality in ARDS

20. ARDS: Prolonged hospital stay was 2.8 folds of average LOS High hospital cost was 4 folds of average hospital cost

21. Discussion 1T. Prasanphanich et al. ARDS in children at Prapokklao Hospital. J Prapokklao Hosp Clin Med Educat Center 2005; 22: 113-20. 2Ekasilp C et al. Acute severe hypoxemic respiratory failure in pediatric patients. J Ped Crit Care Med 2000: 1(suppl): 144. 3Erickson S et al. Acute lung injury in pediatric intensive care in Australia and New Zealand.Pediatr Crit Care Med 2007; 8: 317-23.

22. Conclusions • ARDS is a severe form of respiratory failure in children • The mortality rate in children with ARDS was very high especially in those with complications or organ failure • Reducing the mortality rate is very challenging in pediatric critical care

23. Limitations Retrospective study • undiagnosed cases • incomplete information • unavailable medical records

24. Acknowledgement • The Head of Department of Pediatrics, Faculty of Medicine, Khon Kaen University • Staff in Medical Record and Biostatistic Unit, Srinagarind Hospital, Khon Kaen • The Head and Secretary of PICU, Srinagarind Hospital, Khon Kaen

25. Thank you for your attention