Incidence and risk stratification of pediatric acute respiratory distress syndrome in pediatric intensive care unit.

Abstract

Objective: To determine the incidence and risk stratification of pediatric acute respiratory distress syndrome (PARDS) in mechanically ventilated (MV) patients admitted at the pediatric intensive care unit (PICU). Study Design: Prospective Observational study. Setting: The PICU of National Institute of Child Health, Karachi, Pakistan. Period: April 2024 to March 2025. Methods: A total of 200 children aged 1 month to < 18 years admitted to the PICU with PARDS, and undergoing MV were included. Risk stratification was done on the basis of oxygenation index (OI) categorizing as mild (4 ≤ OI < 8), moderate (8 ≤ OI < 16), and severe (OI ≥ 16). Duration of MV, use of inotropes, PICU stay duration, and mortality were documented and compared with respect to PARDS severity using chi-square test, and Kruskal-Wallis test, taking p<0.05 as significant. Results: Among 200 children, 111 (55.5%) were female, and overall median age was 8.00 (IQR, 4.00–12.00) years. Regarding PARDS categorizations, 24 (12.0%) had mild, 82 (41.0%) moderate, and 94 (47.0%) severe PARDS. Inotropic support was required in 84 (42.0%) patients. Median duration of MV, and PICU stay were 8.00 (5.00–11.00), and 16.00 (12.00–23.00) days, respectively, increasing significantly with severity (p<0.001). Mortality was highest in severe PARDS (21.3%) compared to moderate (2.4%) and mild cases (4.2%) (p<0.001). Conclusion: The PALICC definition and stratification system for PARDS effectively categorize mechanically ventilated pediatric patients into distinct severity groups associated with clinically meaningful differences in ventilator requirements, PICU stay, and mortality.