Nutritional Status and Mechanical Ventilation Practices in Pediatric Acute Respiratory Distress Syndrome: A Secondary Analysis of the 2017-2023 PARDSAsia Study.
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Goh Chen Yun, Leung Karen Ka Yan, Chong Jia Yueh, Zhu Xuemei, Anantasit Nattachai, Fan Lijia, Liu Chunfeng, Ngu Louise, Hon Kam Lun Ellis, Lee Jan Hau, Xu Wei, Kurosawa Hiroshi, Wati Dyah Kanya, Samransamruajkit Rujipat, Huang Li, Jayashree Muralidharan, Chor Yek Kee, Dang Hongxing, Gan Chin Seng, Pon Kah Min, Tai Chian Wern, Phan Phuc Huu, Aoki Kazunori, Liauw Felix, Chuah Soo Lin, Gede Suparyatha Ida Bagus, Lee Pei Chuen, Ong Jacqueline Soo May, Lee Siew Wah, Ong Chengsi, Sultana Rehena, Wong Judith Ju-Ming, Pediatric Acute and Critical Care Medicine Asian Network
Аннотация
DESIGN: The dataset included anthropometric and nutritional data, and body mass index (BMI) z scores were obtained using the World Health Organization standards. Underweight is BMI z score less than -1 and overweight is BMI z score greater than +1. PEEP and F io2 combinations, by the standard grid, in underweight, overweight and normal nutrition groups were compared. Cox proportional hazard regression tested the association between nutrition status and 60-day mortality.
SETTING: Twenty-one PICUs across Asia, 2017-2023.
PATIENTS: PARDSAsia patients met the 2015 International Guidelines for the Diagnosis and Management of PARDS (PALICC) criteria.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Overall, of 693 PARDSAsia patients, we included 625 cases comprising 261 of 625 (41.8%) underweight, 235 of 625 (37.6%) normal, and 129 of 625 (20.6%) overweight patients. Being underweight compared with normal or overweight status, was associated with younger median (interquartile range) age: respectively, 1.0 (0.3, 3.7) vs. 1.4 (0.5, 4.6) vs. 1.9 (0.7, 8.5) years ( p < 0.001). The prescription of PEEP was more conservative in patients who were underweight compared with patients of normal or overweight nutritional status: PEEP/F io2 combinations were, respectively, -1.7 (-3.3, 0.0) vs. -0.9 (-2.7, 0.0) vs. -0.6 (-1.8, 0.4) cm H 2 O below recommended grid value ( p < 0.001). Underweight nutritional status was associated with greater risk of 60-day mortality (adjusted hazard ratio 1.85 [95% CI, 1.14-3.01]).
CONCLUSIONS: Underweight nutritional status was prevalent among children within the PARDSAsia 2017-2023 dataset and was associated with poor clinical outcomes. The prescription of PEEP was more conservative in underweight patients compared with those with normal or overweight status.