Predictors of Outcomes in Pediatric Acute Respiratory Distress Syndrome at a Tertiary Care Hospital.

OBJECTIVES

Acute respiratory distress syndrome (ARDS) in children remains a critical cause of morbidity and mortality worldwide, yet regional data from Kashmir are limited. This study aimed to evaluate the predictors of outcomes among pediatric ARDS cases admitted to a tertiary care center.

METHODS

A prospective observational study was conducted over two years, enrolling 40 children diagnosed with ARDS at a pediatric department using a consecutive sampling method. Demographic characteristics, clinical features, laboratory trends, arterial blood gas (ABG) parameters, and severity scores (Lung Injury Score (LIS), Pediatric Sequential Organ Failure Assessment (pSOFA), and Pediatric Risk of Mortality III (PRISM III)) were analyzed to identify factors associated with disease progression and mortality.

RESULTS

Most affected children were below six years of age, with male children comprising the majority. Fever, cough, tachypnea, crepitations, and hypoxemia were main clinical features. A significant rise in blood urea and creatinine emerged during progression, reflecting renal involvement. High total leukocyte count (TLC), neutrophilia, and inflammatory markers were associated with severe disease. Non-survivors exhibited markedly deranged ABG profiles-including lower pH, reduced PO₂, and elevated lactate-indicating uncompensated hypoxia and acidosis. Severity indices (LIS, pSOFA, and PRISM III) and oxygenation parameters significantly predicted mortality. Multiorgan dysfunction, particularly renal and hepatic impairment, was more frequent in non-survivors.

CONCLUSION

ARDS continues to carry high mortality in resource-limited settings. Younger age, elevated inflammatory and organ dysfunction markers, worsening ABG parameters, and higher severity scores were strongly associated with poor outcomes. Early identification of high-risk children, timely escalation of respiratory support, improved referral pathways, and strengthening of pediatric critical care services are essential to enhance survival in the region.