Pediatric ARDS phenotypes in critical COVID-19: implications for therapies and outcomes

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dc.contributor.authorDíaz, Francoes
dc.contributor.authorDomínguez-Rojas, Jesúses
dc.contributor.authorLuna-Delgado, Yesicaes
dc.contributor.authorCaqui-Vilca, Patrickes
dc.contributor.authorMartel-Ramírez, Carloses
dc.contributor.authorQuispe-Chipana, Migueles
dc.contributor.authorCruz-Arpi, Marioes
dc.contributor.authorAtamari-Anahui, Noées
dc.contributor.authorMuñoz Ramírez, Cleotilde Mireyaes
dc.contributor.authorQuispe Flores, Gaudies
dc.contributor.authorTello-Pezo, Marielaes
dc.contributor.authorCruces, Pabloes
dc.contributor.authorVásquez-Hoyos, Pabloes
dc.date.accessioned2023-05-17T16:42:34Z
dc.date.available2023-05-17T16:42:34Z
dc.date.issued2022-06
dc.description.abstractPurpose to describe lung mechanics in Pediatric Acute Respiratory Disease Syndrome (PARDS) associated with COVID-19. We hypothesize two phenotypes according to respiratory system mechanics and clinical diagnosis. Methods a concurrent multicenter observational study was performed, analyzing clinical variables and pulmonary mechanics of PARDS associated with COVID-19 in 4 Pediatric intensive care units (PICUs) of Perú. Subgroup analysis included PARDS associated with multisystem inflammatory syndrome in children (MIS-C), MIS-PARDS, and PARDS with COVID-19 primary respiratory infection, C-PARDS. In addition, receiver operator curve analysis (ROC) for mortality was performed. Results 30 patients were included. Age was 7.5(4-11) years, 60% male, and mortality 23%. 47% corresponded to MIS-PARDS and 53% to C-PARDS phenotypes. C-PARDS had positive RT-PCR in 67% and MIS-PARDS none (p<0.001). C-PARDS group had more profound hypoxemia (P/Fratio<100, 86%vs38%,p<0.01) and higher driving-pressure (DP) [14(10-22)vs10(10-12)cmH2O], and lower compliance of the respiratory system (CRS)[0.5(0.3-0.6)vs 0.7(0.6-0.8)ml/kg/cmH2O] compared to MIS-PARDS (all p<0.05). ROC-analysis for mortality showed that DP had the best performance [AUC 0.91(95%CI0.81-1.00), with the best cut-point of 15 cmH2O (100% sensitivity and 87% of specificity). Mortality in C-PARDS was 38% and 7% in MIS-PARDS(p=0.09). MV free-days were 12(0-23) in C-PARDS and 23(21-25) in MIS-PARDS(p=0.02) Conclusion critical pediatric COVID-19 is heterogeneous in children. COVID-19 PARDS had two phenotypes with distinctive pulmonary mechanics features. Characteristics of C-PARDS are like a classic primary PARDS, while a decoupling between compliance and hypoxemia was more frequent in MIS-PARDS. In addition, C-PARDS had fewer MV free-days. DP ≥ 15 cmH2O had the best performance of the quasi-static calculations to discriminate for mortality. Standardized pulmonary mechanics measurements in PARDS might reveal essential information to tailor the ventilatory strategy in pediatric critical COVID-19.es
dc.identifier.citationMedRxiv: The Preprint Server for Health Sciences, N° 22276125, (2022) p. 1-26.en
dc.identifier.doihttps://doi.org/10.1101/2022.06.08.22276125
dc.identifier.orcidhttps://orcid.org/0000-0003-4763-074X
dc.identifier.urihttp://hdl.handle.net/20.500.12254/3250
dc.languageenen_US
dc.publisherYale University; Cold Spring Harbor Laboratory (CSHL)en
dc.rightsAtribución-NoComercial-CompartirIgual 3.0 Chile (CC BY-NC-SA 3.0 CL)en_US
dc.rights.urihttp://creativecommons.org/licenses/by-nc-sa/3.0/cl/en_US
dc.subjectPediatricsen_US
dc.subjectCOVID-19en_US
dc.subjectMechanical ventilationen_US
dc.subjectPandemicen_US
dc.titlePediatric ARDS phenotypes in critical COVID-19: implications for therapies and outcomeses
dc.typeArtículoes
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