Whole pulmonary assessment 1 year after paediatric acute respiratory distress syndrome: prospective multicentre study.
ARDS
Child
Computed tomography
Long-term outcomes
Pulmonary function
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
20 Aug 2022
20 Aug 2022
Historique:
received:
22
03
2022
accepted:
03
08
2022
entrez:
20
8
2022
pubmed:
21
8
2022
medline:
21
8
2022
Statut:
epublish
Résumé
Long-term pulmonary sequelae, including 1-year thoracic computed tomography (CT) sequelae of paediatric acute respiratory distress syndrome (ARDS) remain unknown. The purpose of the study was to determine pulmonary abnormalities in child survivors of pulmonary (p-ARDS) and extra-pulmonary ARDS (ep-ARDS) 1 year after paediatric intensive care unit discharge (PICUD). Prospective multicentre study in four paediatric academic centres between 2005 and 2014. Patients with ARDS were assessed 1 year after PICUD with respiratory symptom questionnaire, thoracic CT and pulmonary function tests (PFT). 39 patients (31 p-ARDS) aged 1.1-16.2 years were assessed. Respiratory symptoms at rest or exercise and/or respiratory maintenance treatment were reported in 23 (74%) of children with p-ARDS but in 1 (13%) of those with ep-ARDS. Thoracic CT abnormalities were observed in 18 (60%) of children with p-ARDS and 4 (50%) of those with ep-ARDS. Diffuse and more important CT abnormalities, such as ground glass opacities or mosaic perfusion patterns, were observed in 5 (13%) of children, all with p-ARDS. PFT abnormalities were observed in 30 (86%) of patients: lung hyperinflation and/or obstructive pattern in 12 (34%) children, restrictive abnormalities in 6 (50%), mild decrease in diffusing capacity in 2 (38%) and 6-min walking distance decrease in 11 (73%). Important PFT abnormalities were observed in 7 (20%) children, all with p-ARDS. Increasing driving pressure (max plateau pressure-max positive end-expiratory pressure) was correlated with increasing CT-scan abnormalities and increasing functional residual capacity (more hyperinflation) (p < 0.005). Children surviving ARDS requiring mechanical ventilation present frequent respiratory symptoms, significant CT-scan and PFT abnormalities 1 year after PICUD. This highlights the need for a systematic pulmonary assessment of these children. Trial registration The study was registered on Clinical Trials.gov PRS (ID NCT01435889).
Sections du résumé
BACKGROUND
BACKGROUND
Long-term pulmonary sequelae, including 1-year thoracic computed tomography (CT) sequelae of paediatric acute respiratory distress syndrome (ARDS) remain unknown. The purpose of the study was to determine pulmonary abnormalities in child survivors of pulmonary (p-ARDS) and extra-pulmonary ARDS (ep-ARDS) 1 year after paediatric intensive care unit discharge (PICUD).
METHODS
METHODS
Prospective multicentre study in four paediatric academic centres between 2005 and 2014. Patients with ARDS were assessed 1 year after PICUD with respiratory symptom questionnaire, thoracic CT and pulmonary function tests (PFT).
RESULTS
RESULTS
39 patients (31 p-ARDS) aged 1.1-16.2 years were assessed. Respiratory symptoms at rest or exercise and/or respiratory maintenance treatment were reported in 23 (74%) of children with p-ARDS but in 1 (13%) of those with ep-ARDS. Thoracic CT abnormalities were observed in 18 (60%) of children with p-ARDS and 4 (50%) of those with ep-ARDS. Diffuse and more important CT abnormalities, such as ground glass opacities or mosaic perfusion patterns, were observed in 5 (13%) of children, all with p-ARDS. PFT abnormalities were observed in 30 (86%) of patients: lung hyperinflation and/or obstructive pattern in 12 (34%) children, restrictive abnormalities in 6 (50%), mild decrease in diffusing capacity in 2 (38%) and 6-min walking distance decrease in 11 (73%). Important PFT abnormalities were observed in 7 (20%) children, all with p-ARDS. Increasing driving pressure (max plateau pressure-max positive end-expiratory pressure) was correlated with increasing CT-scan abnormalities and increasing functional residual capacity (more hyperinflation) (p < 0.005).
CONCLUSIONS
CONCLUSIONS
Children surviving ARDS requiring mechanical ventilation present frequent respiratory symptoms, significant CT-scan and PFT abnormalities 1 year after PICUD. This highlights the need for a systematic pulmonary assessment of these children. Trial registration The study was registered on Clinical Trials.gov PRS (ID NCT01435889).
Identifiants
pubmed: 35986824
doi: 10.1186/s13613-022-01050-4
pii: 10.1186/s13613-022-01050-4
pmc: PMC9392829
doi:
Banques de données
ClinicalTrials.gov
['NCT01435889']
Types de publication
Journal Article
Langues
eng
Pagination
79Subventions
Organisme : The study was supported, in part, by grant from the French Ministry of Health (Programme Hospitalier de Recherche Clinique Régional)
ID : 2005/1906
Informations de copyright
© 2022. The Author(s).
Références
Quasney MW, López-Fernández YM, Santschi M, Watson RS, Pediatric Acute Lung Injury Consensus Conference Group. The outcomes of children with pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(51):S118-131.
doi: 10.1097/PCC.0000000000000438
Boucher V, Mathy C, Lacroix J, Émériaud G, Jouvet P, Tse SM. Post-discharge respiratory outcomes of children with acute respiratory distress syndrome. Pediatr Pulmonol. 2020;55(2):468–73.
doi: 10.1002/ppul.24581
Cheifetz IM. Pediatric ARDS. Respir Care. 2017;62(6):718–31.
doi: 10.4187/respcare.05591
Kim SJ, Oh BJ, Lee JS, Lim CM, Shim TS, Lee SD, et al. Recovery from lung injury in survivors of acute respiratory distress syndrome: difference between pulmonary and extrapulmonary subtypes. Intensive Care Med. 2004;30(10):1960–3.
doi: 10.1007/s00134-004-2374-6
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, The American-European Consensus Conference on ARDS, et al. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149(3 Pt 1):818–24.
doi: 10.1164/ajrccm.149.3.7509706
Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5):428–39.
doi: 10.1097/PCC.0000000000000350
Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, et al. Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012;40(6):1324–43.
doi: 10.1183/09031936.00080312
Stanojevic S, Graham BL, Cooper BG, Thompson BR, Carter KW, Francis RW, et al. Official ERS technical standards: global Lung Function Initiative reference values for the carbon monoxide transfer factor for Caucasians. Eur Respir J. 2017;50(3).
Quanjer PH, Stanojevic S, Cole TJ, Stocks J. GLI-2012 Data Conversion software. http://www.lungfunction.org/files/Install-GLI2012_DataConversion.EXE .
Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows. Eur Respir J Suppl. 1993;16:5–40.
doi: 10.1183/09041950.005s1693
Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26(5):948–68.
doi: 10.1183/09031936.05.00035205
Rimensberger PC, Cheifetz IM, Group for the PALICC. Ventilatory support in children with pediatric acute respiratory distress syndrome: proceedings from the pediatric acute lung injury consensus conference. Pediatr Crit Care Med. 2015;16(5_suppl):S51.
doi: 10.1097/PCC.0000000000000433
Wilcox ME, Patsios D, Murphy G, Kudlow P, Paul N, Tansey CM, et al. Radiologic outcomes at 5 years after severe ARDS. Chest. 2013;143(4):920–6.
doi: 10.1378/chest.12-0685
Howling SJ, Evans TW, Hansell DM. The significance of bronchial dilatation on CT in patients with adult respiratory distress syndrome. Clin Radiol. 1998;53(2):105–9.
doi: 10.1016/S0009-9260(98)80055-X
Masclans JR, Roca O, Muñoz X, Pallisa E, Torres F, Rello J, et al. Quality of life, pulmonary function, and tomographic scan abnormalities after ARDS. Chest. 2011;139(6):1340–6.
doi: 10.1378/chest.10-2438
Desai SR, Wells AU, Rubens MB, Evans TW, Hansell DM. Acute respiratory distress syndrome: CT abnormalities at long-term follow-up. Radiology. 1999;210(1):29–35.
doi: 10.1148/radiology.210.1.r99ja2629
Nöbauer-Huhmann IM, Eibenberger K, Schaefer-Prokop C, Steltzer H, Schlick W, Strasser K, et al. Changes in lung parenchyma after acute respiratory distress syndrome (ARDS): assessment with high-resolution computed tomography. Eur Radiol. 2001;11(12):2436–43.
doi: 10.1007/s003300101103
Newth CJL, Sward KA, Khemani RG, Page K, Meert KL, Carcillo JA, et al. Variability in usual care mechanical ventilation for pediatric Acute Respiratory Distress Syndrome: time for a decision support protocol? Pediatr Crit Care Med. 2017;18(11):e521–9.
doi: 10.1097/PCC.0000000000001319
Chakdour S, Vaidya PC, Angurana SK, Muralidharan J, Singh M, Singhi SC. Pulmonary functions in children ventilated for acute hypoxemic respiratory failure. Pediatr Crit Care Med. 2018;19(9): e464.
doi: 10.1097/PCC.0000000000001635
Desai SR. Acute respiratory distress syndrome: imaging of the injured lung. Clin Radiol. 2002;57(1):8–17.
doi: 10.1053/crad.2001.0889
Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293–304.
doi: 10.1056/NEJMoa1011802
Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, et al. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003;348(8):683–93.
doi: 10.1056/NEJMoa022450
Ward SL, Turpin A, Spicer AC, Treadwell MJ, Church GD, Flori HR. Long term pulmonary function and quality of life in children after acute respiratory distress syndrome: a feasibility investigation. Pediatr Crit Care Med. 2017;18(1):e48-55.
doi: 10.1097/PCC.0000000000001014
Ben-Abraham R, Weinbroum AA, Roizin H, Efrati O, Augarten A, Harel R, et al. Long-term assessment of pulmonary function tests in pediatric survivors of acute respiratory distress syndrome. Med Sci Monit. 2002;8(3):CR153-157.
pubmed: 11887027