Acute respiratory failure (ARF) is one of the most common reasons for admission to a paediatric intensive care unit. The short-term and long-term effects on pulmonary health are unknown, as well as what factors contribute to chronic pulmonary dysfunction. An episode of ARF, severe enough, usually requires mechanical ventilation (MV), further contributing to pulmonary dysfunction. Based on these observations, Dr Garrett Keim (Childrenâs Hospital of Philadelphia, USA) and colleagues hypothesised that severity of ARF and the course of MV, as well as pulmonary dysfunction at discharge (PDAD) will predict chronic pulmonary dysfunction at 6- and 12-months follow-up.
A cohort of previously healthy infants, >2 years old, who required MV for ARF were prospectively recruited from multiple centres. These infants had an extensive recording of paediatric intensive care unit and hospital course. PDAD was defined as requiring at least one of the following at 28 days of hospital discharge: MV, supplemental oxygen, bronchodilators, or steroids. Follow-up status was determined for 158 (61%) cases at 6 months and 130 (50%) patients at 12 months. Chronic pulmonary dysfunction (CPD) was defined as having a Paediatric Quality of Life score â„5. Other criteria that determined persistent CPD were being diagnosed with asthma, requiring medication such as bronchodilators or inhaled steroids therapy, or having an unscheduled clinical assessment for respiratory symptoms. Multivariate backward stepwise regression analysis was applied to determine independent predictors of PDAD at hospital discharge and CPD at 6 and 12 months.
PDAD was present in 87 out of 255 (34.1%) infants at hospital discharge. Patients with a positive bacterial culture strongly predicted PDAD upon leaving the hospital (OR 4.38; CI, 1.66-11.56). Furthermore, the nadir oxygenation index was the only ventilator characteristic or severity of illness measure that was found to be a predictor of PDAD (OR 1.07; CI, 1.02-1.12). At 6-month follow-up, 66 out of 158 patients (41.8%) were found to have CPD. At 12 months, CPD was observed in 57 out of 130 (43.8%) infants. The results also showed that CPD at 6 months was strongly predictive of 12 months CPD. These results are summarised in Table 1.
Table 1: Multivariable model for predictors of CPD at 6 and 12 months [1]
Dr Keim and his team concluded that the development of CPD is common in previously healthy infants experiencing an episode of ARF and in need of MV. A positive bacterial respiratory culture is related to ongoing CPD to at least 12 months follow-up. PDAD predicted CPD at 6 months, which in turn was strongly associated with continued CPD at 12 months.
- Keim G, et al. Bacterial Pneumonia Predicts Ongoing Chronic Pulmonary Dysfunction in Previously Healthy Infants. A27, ATS 2019, 17-22 May, Dallas, Texas, USA.
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Table of Contents: ATS 2019
Featured articles
Letter from the Editor
Interview with Prof. Christian Bergmann
Treatable Traits in Chronic Inflammatory Airway Disease: Back to Basics
Treatable traits in chronic inflammatory airway disease: back to basics
Critical Care Medicine
Distinguishing between 4 different subtypes of sepsis sets the stage for individualised treatment
Stem cell therapy in acute respiratory distress syndrome improves 28-day mortality
SPICE III trial: Early sedation with dexmedetomidine in critically ill patients
SAATELLITE trial: Suvratoxumab prevents ventilator-associated Staphylococcus Aureus pneumonia in intensive care unit patients
Sleep Medicine
Million-patient study reveals gaps in long-term adherence among various sub-populations
Sleep apnoea severity has a non-linear relationship with acute myocardial infarction risk
Obstructive sleep apnoea affects morning spatial navigational memory processing in asymptomatic older individuals
Pulmonary Vascular Disease and Interstitial Lung Disease
Nintedanib reduces lung function decline in systemic sclerosis-associated ILD
Pulmonary arterial hypertension: early treatment with selexipag most effective
Long-term safety and efficacy of recombinant human pentraxin-2 in patients with idiopathic pulmonary fibrosis
Infection
Dupilumab improves outcomes in patients with severe chronic rhinosinusitis with nasal polyps and comorbid asthma
Durability of culture conversion in patients receiving ALIS for treatment-refractory MAC lung disease
E-cigarette use disrupts normal immune response to viral infections, particularly in women
Paediatric Pulmonary Medicine
Bacterial pneumonia predicts ongoing lung problems in infants hospitalised for acute respiratory failure
Aspergillus and early cystic fibrosis lung disease: does it need to be treated?
COPD
CORTICO-COP trial: eosinophil-guided therapy reduces systemic corticosteroid exposure
A randomised controlled trial of a smoking cessation smartphone application
Benralizumab does not ameliorate COPD exacerbations (GALATHEA/TERRANOVA trials)
Aclidinium bromide delays COPD exacerbation without increased MACE risk
Bench-to-Bedside (Pre-Clinical)
Human lung organoids to study foetal RSV infection
CRISPR/Cas9 genome editing therapy of hereditary pulmonary alveolar proteinosis
Cilia diagnostics in primary ciliary dyskinesia
Tuberous sclerosis complex 2 may be a novel target in pulmonary arterial hypertension therapy
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