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

Journal of Clinical Medicine

on behalf the Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in Children (PANDORA-CHILD) Network¹  Jesús Villar²  Arthur S. Slutsky³  María García-González⁴  José M. González-Gómez⁵  Juan Mayordomo-Colunga⁶  Laura Butragueño-Laiseca⁷  Ana Gómez-Zamora⁸  Rocío Núñez-Borrero⁹  Paula Madurga-Revilla^1,10  Amelia Martínez-de-Azagra^1,11  Patricia Rodríguez-Campoy^1,12  César Pérez-Caballero Macarrón^1,13  María Miñambres-Rodríguez^1,14  Julio Parrilla-Parrilla^1,15  Yolanda M. López-Fernández^1,16  Jesús M. González-Martín^1,17 

[1] ;CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 20029 Madrid, Spain;Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON M5S 1A4, Canada;Pediatric Intensive Care Unit, Complejo Hospitalario de Burgos, 09006 Burgos, Spain;Pediatric Intensive Care Unit, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain;Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Instituto de Investigación del Principado de Asturias, 33006 Oviedo, Spain;Pediatric Intensive Care Unit, Hospital Universitario Gregorio Marañón, 28009 Madrid, Spain;Pediatric Intensive Care Unit, Hospital Universitario La Paz, 28046 Madrid, Spain;Pediatric Intensive Care Unit, Hospital Universitario Materno-Infantil, 35016 Las Palmas de Gran Canaria, Spain;Pediatric Intensive Care Unit, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain;Pediatric Intensive Care Unit, Hospital Universitario Niño Jesús, 28009 Madrid, Spain;Pediatric Intensive Care Unit, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain;Pediatric Intensive Care Unit, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;Pediatric Intensive Care Unit, Hospital Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;Pediatric Intensive Care Unit, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain;Pediatric Intensive Care Unit, Hospital Universitario de Cruces, Biocruces-Bizkaia Health Research Institute, 48903 Barakaldo, Spain;Research Unit, Hospital Universitario Dr. Negrín, 35019 Las Palmas de Gran Canaria, Spain;

关键词: children;    acute hypoxemic respiratory failure;    acute respiratory distress syndrome;    coronavirus disease 2019;    mechanical ventilation;   

DOI  :  10.3390/jcm10194301

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown