Ravindranath TM, Gomez A, Harwayne-Gidansky I, Connors TJ, Neill N, Levin B, Howell JD, Saiman L, Baird JS. Pediatric acute respiratory distress syndrome associated with human metapneumovirus and respiratory syncytial virus.
Pediatr Pulmonol 2018;
53:929-935. [PMID:
29737017 DOI:
10.1002/ppul.24044]
[Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 04/20/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES
To study the incidence, risk factors, clinical course, and outcome of ARDS in children with HMP and RSV.
WORKING HYPOTHESIS
We hypothesized that ARDS in children with HMP was similar in incidence, risk factors, clinical course, and outcomes to ARDS in children with RSV.
STUDY DESIGN
Retrospective, observational study over 2 years.
PATIENT-SUBJECT SELECTION
Patients included were <18 years old with HMP or RSV detected from nasopharyngeal specimens by commercial reverse transcriptase polymerase chain reaction assay admitted to a study site.
METHODOLOGY
We described the incidence of ARDS within 1 week following the detection of HMP or RSV using recently developed Pediatric ARDS (PARDS) criteria. We also assessed risk factors, clinical course, and outcomes of children in the PICU with HMP or RSV and PARDS or non-PARDS.
RESULTS
We identified 57 patients with HMP and 161 patients with RSV: the proportions of patients with either virus who developed PARDS (HMP: 23%, RSV: 20%) and severe PARDS (HMP: 9%, RSV: 7%) were similar, as were the proportions of patients with acute (or acute-on-chronic) respiratory failure who developed PARDS (HMP: 41%, RSV: 31%). In a logistic regression model, risk factors associated with PARDS included neurologic comorbidity and PIM 3 probability of mortality, but not virus type. The risk factors, clinical course, and outcomes were similar for patients with PARDS associated with HMP and RSV.
CONCLUSIONS
About 1/3 of children with HMP or RSV and acute (or acute-on-chronic) respiratory failure developed PARDS. Children with either virus and a neurologic comorbidity or an increased PIM 3 probability of mortality were at increased risk for PARDS.
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