Garrett P. Keim
Young children with bacterial pneumonia who were admitted to a pediatric ICU frequently had lung problems that lasted up to a year after discharge, according to research presented at the American Thoracic Society International Conference.
Garrett P. Keim, MD, a pediatric critical care medicine fellow in the department of anesthesiology and critical care medicine at Children’s Hospital of Philadelphia, said most children recover from acute respiratory failure (ARF), but “there are children who die every year” from the condition.
For their study, Keim and colleagues prospectively recruited previously healthy children aged younger than 2 years (n = 259) who required mechanical ventilation for ARF.
The researchers examined whether ARF severity, mechanical ventilation course or pulmonary dysfunction at discharge (PDAD) could predict chronic pulmonary dysfunction (CPD) 6 and 12 months after discharge. Patients with PDAD were defined as needing mechanical ventilation, supplemental oxygen, bronchodilators or steroids. Patients with ongoing CPD were defined as having a respiratory Pediatric Quality of Life Inventory score of 5 or higher or an asthma diagnosis, requiring bronchodilator or inhaled steroid therapy or having an unscheduled clinical evaluation for respiratory symptoms.
Among the 255 survivors, 87 (34.1%) had PDAD. According to the researchers, a strong predictor of PDAD was a positive bacterial culture (OR = 4.38; 95% CI, 1.66-11.56). The only ventilator characteristic or severity of illness measure associated with PDAD was nadir oxygenation index (OR = 1.07; 95% CI, 1.02-1.12).
CPD was identified in 66 of 158 children (41.8%) at the 6-month follow-up and 57 of 130 children (43.8%) at the 12-month follow-up. Those who had PDAD were more likely to have CPD at 6 months, and 6-month CPD strongly predicted 12-month CPD. Positive bacterial respiratory cultures taken during the initial hospitalization were predictive of CPD at both the 6- and 12-month follow-up.
Keim said that understanding the predictors of CPD could assist pediatrics intensivists in identifying children who are at increased risk for the condition and help to put in place supportive care measures, including physical or occupational therapy or rehabilitation. The children could also be referred to pediatric pulmonologists, who can follow the patients after hospitalization. – by Katherine Bortz
Keim G, et al. A1197/917. Presented at: ATS International Conference; May 17-22, 2019; Dallas, Texas.
Disclosure: Keim reports no relevant financial disclosures.