TY - JOUR T1 - Comparison of Prognostic Factors Between Direct and Indirect Pediatric ARDS JF - Respiratory Care DO - 10.4187/respcare.07605 SP - respcare.07605 AU - Da Hyun Kim AU - Eun Ju Ha AU - Seong Jong Park AU - Won Kyoung Jhang Y1 - 2020/07/14 UR - http://rc.rcjournal.com/content/early/2020/07/14/respcare.07605.abstract N2 - BACKGROUND: Pediatric ARDS is a heterogeneous disease entity with high morbidity and mortality. In this study, we categorized pediatric ARDS by direct and indirect initial triggering events and identified characteristics of survivors and nonsurvivors in these 2 subtypes.METHODS: This was a single-center, retrospective, observational study that included critically ill subjects with pediatric ARDS (age 1 month to 18 y) who had undergone mechanical ventilation support and had been admitted to our 14-bed, multidisciplinary, tertiary pediatric medical ICU between January 2010 and March 2019.RESULTS: A total of 162 subjects with pediatric ARDS were included. The direct ARDS subtype accounted for 128 cases, and 34 cases were classified as indirect ARDS. The most common initiating events were pneumonia and sepsis for direct and indirect ARDS, respectively. Subjects with indirect ARDS had higher serum lactate levels, greater Pediatric Risk of Mortality III (PRISM III) and Pediatric Sequential Organ Failure Assessment (pSOFA) scores than those with direct ARDS (P < .05). Nonsurvivors with the direct subtype had worse mechanical ventilation-related parameters, including FIO2, PEEP, P̄aw, peak inspiratory pressure, oxygenation index, and Pao2/FIo2 ratio than survivors with the direct subtype. The likelihood of mortality rose with the severity of ARDS in association with the direct subtype but not with the indirect subtypes. Among children with indirect ARDS, lactate levels and pSOFA scores were significantly higher among nonsurvivors than survivors.CONCLUSIONS: Direct and indirect pediatric ARDS had distinct clinical characteristics, especially in terms of prognostic factors. Variables related to mechanical ventilation were significantly associated with mortality among subjects with direct pediatric ARDS, but not among subjects with indirect pediatric ARDS. Thus, this study provides evidence of the potential benefit of categorizing patients with pediatric ARDS by subtype for evaluating prognostic factors and developing adjusted management strategies to improve clinical outcomes. ER -