PARDS in Children With Lower Respiratory Tract Infection: A BACON (Bronchiolitis and Co-DetectioN) Sub-Study
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Pulmonary, Pediatrics, 2022
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INTRODUCTION: Bronchiolitis and other lower respiratory tract infections (LRTI) are the most common causes of pediatric respiratory failure. Because there are insufficient data characterizing Pediatric ARDS (PARDS) in young children with LRTI to inform clinical management, we aimed to describe their clinical and demographic characteristics and identify factors associated with PARDS development. METHODS: We performed a sub-analysis of data from Bronchiolitis And CO-detectioN (BACON), an IRB-approved international prospective observational study of critical bronchiolitis at 43 sites from 12/2019 to 11/2020. Inclusion criteria were age < 2 years, endotracheal intubation, and acute LRTI. We used Chi squared and Wilcoxon rank sum to compare PARDS patients (meeting PALICC OI/OSI criteria during the first full calendar day following intubation) to non-PARDS patients. Bacterial co-detection was defined as a respiratory culture with both moderate/many PMNs and growth of moderate/many bacteria. Data are shown as n (%) and median (IQR). RESULTS: Complete data were available for 438 children from 41 sites. PARDS was diagnosed in 290 (66%) subjects and was associated with increased mortality (7.3% vs 1.4% [p=0.009]), greater duration of mechanical ventilation (166 [110.8, 261] vs 116 [72.6, 181.6] hours [p < 0.0001]), and PICU length of stay (11.1 [7.6, 16] vs 7.5 [5, 11.6] days, [p < 0.0001]). PARDS was associated with older age (5 [1.6, 11.1] vs 2.4 [1.3, 7.9] months [p=0.005]) and history of previous admission with wheezing (13% vs 6.1% [p=0.025]). PARDS was not associated with comorbidities, home medications (bronchodilators, steroids, or diuretics), or family history of atopy. Children with PARDS were less likely to have a positive respiratory culture (43 vs 54% [p=0.030]), but had no difference in meeting bacterial co-detection criteria (31% vs 26% [p=0.286]). PARDS subjects were treated with higher PEEP (8 [6, 9] vs 7 [6, 8] [p < 0.0001]) and mean airway pressures (14 [12, 16] vs 12 [10, 13] [p < 0.0001]). CONCLUSIONS: PARDS is common in patients intubated for LRTI and is associated with increased mortality, duration of mechanical ventilation, and PICU length of stay. Many factors were associated with the development of PARDS and prospective studies are needed to elucidate optimal management of critical bronchiolitis.
Meta Tag
Content Type Presentation
Knowledge Area Pulmonary
Knowledge Area Pediatrics
Knowledge Level Advanced
Membership Level Select
Tag Acute Respiratory Distress Syndrome ARDS
Tag Pediatrics
Tag Ventilation
Tag Respiratory Syncytial Virus RSV
Year 2022
Pediatric Acute Respiratory Distress Syndrome
lower respiratory tract infections
BACON study
mechanical ventilation


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