Epidemiology of Pediatric Sepsis & septic shock in Asia: Clinical presentations, risk factors, management — collaboration with Pediatric Sepsis Asian collaboration (PEDSAC)
Pediatric acute respiratory distress syndrome (PARDS) Ventilation Bundle [Pilot @ KK Women’s and Children’s Hospital] — ClinicalTrials.gov Identifier: NCT03504176
Does 3% hypertonic saline decrease mortality and improve long-term neurological outcomes among children with traumatic brain injury?
Variation in intensive care practices for moderate to severe traumatic brain injury: A multi-national initiative.
Risk Stratification in Pediatric Acute Respiratory Distress Syndrome: A Multicenter Observational Study
Study description: The Pediatric Acute Lung Injury Consensus Conference (PALICC) developed a pediatric speciﬁc deﬁnition for acute respiratory distress syndrome (PARDS). In this definition, severity of lung disease is stratified into mild, moderate and severe groups. We aim to describe the epidemiology of patients with PARDS across Asia and evaluate whether the PALICC risk stratification accurately predicts outcome in PARDS. This is a multicenter, retrospective, descriptive cohort study involving 10 multidisciplinary pediatric intensive care units in Asia.
Main findings: A total of 373 patients had mild [89(23.9%)], moderate [149 (39.9%)] and severe PARDS [135 (36.2%)]. Higher category of severity of PARDS was associated with lower ventilator free days [22 (17, 25), 16 (0, 23), 6 (0, 19); p<0.001 for mild, moderate and severe, respectively] and PICU free days [19 (11, 24), 15 (0, 22), 5 (0, 20); p<0.001 for mild, moderate and severe, respectively]. Overall PICU mortality for PARDS was 113/373 (30.3%), and 100-day mortality was 126/314 (39.7%). After adjusting for site, presence of comorbidities and severity of illness in the multivariate Cox proportional hazard regression model, patients with moderate [hazard ratio (HR) 1.88, 95% confidence interval (CI): 1.03, 3.45; p=0.039] and severe PARDS [HR 3.18 (95% CI 1.68, 6.02); p<0.001] had higher risk of mortality compared to those with mild PARDS.
- Differences Between Pulmonary and Extrapulmonary Pediatric Acute Respiratory Distress Syndrome: A Multicenter Analysis
Study description: Pediatric acute respiratory distress syndrome caused by extrapulmonary (PARDSexp) and pulmonary (PARDSp) etiologies is poorly described in the literature. We aimed to describe and compare the epidemiology, risk factors for mortality, and outcomes in PARDSexp and PARDSp. This is a secondary analysis of a multicenter, retrospective, cohort study. Patients were classified into two mutually exclusive groups (PARDSexp and PARDSp) based on etiologies. Primary outcome was pediatric intensive care unit mortality. Cox proportional hazard regression was used to identify risk factors for mortality.
Main findings: Children with PARDSexp had higher admission severity scores, and had a greater proportion of organ dysfunction compared to PARDSp group. Patients in the PARDSexp group had higher mortality (48.8% vs. 24.8%; p = 0.002) and reduced ventilator-free days [median 2.0 (interquartile range 0.0, 18.0) vs. 19.0 (0.5, 24.0) days; p = 0.001] compared to the PARDSp group. However, after adjusting for site, severity of illness, comorbidities, multiorgan dysfunction, and severity of acute respiratory distress syndrome, PARDSexp etiology was not associated with mortality [adjusted hazard ratio 1.56 (95% confidence interval 0.90, 2.71)].