J Clin Med . Acute Hypoxemic Respiratory Failure in Children at the Start of COVID-19 Outbreak: A Nationwide Experience

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J Clin Med


. 2021 Sep 22;10(19):4301.
doi: 10.3390/jcm10194301.
Acute Hypoxemic Respiratory Failure in Children at the Start of COVID-19 Outbreak: A Nationwide Experience


Yolanda M López-Fernández ¹ , Amelia Martínez-de-Azagra ² , José M González-Gómez ³ , César Pérez-Caballero Macarrón ⁴ , María García-González ⁵ , Julio Parrilla-Parrilla ⁶ , María Miñambres-Rodríguez ⁷ , Paula Madurga-Revilla ⁸ , Ana Gómez-Zamora ⁹ , Patricia Rodríguez-Campoy ¹⁰ , Juan Mayordomo-Colunga ^{11 12} , Laura Butragueño-Laiseca ¹³ , Rocío Núñez-Borrero ¹⁴ , Jesús M González-Martín ¹⁵ , Arthur S Slutsky ^{16 17} , Jesús Villar ^{12 17 18} , On Behalf The Prevalence And Outcome Of Acute Hypoxemic Respiratory Failure In Children Pandora-Child Network



Affiliations

• PMID: 34640318
• DOI: 10.3390/jcm10194301

Abstract

Study design: This is a prospective, multicenter, and observational study with the aim of describing physiological characteristics, respiratory management, and outcomes of children with acute hypoxemic respiratory failure (AHRF) from different etiologies receiving invasive mechanical ventilation (IMV) compared with those affected by SARS-CoV-2.
Methods and main results: Twenty-eight patients met the inclusion criteria: 9 patients with coronavirus disease 2019 (COVID-19) and 19 patients without COVID-19. Non-COVID-19 patients had more pre-existing comorbidities (78.9% vs. 44.4%) than COVID-19 patients. At AHRF onset, non-COVID-19 patients had worse oxygenation (PaO₂/FiO₂ = 95 mmHg (65.5-133) vs. 150 mmHg (105-220), p = 0.04), oxygenation index = 15.9 (11-28.4) vs. 9.3 (6.7-10.6), p = 0.01), and higher PaCO₂ (48 mmHg (46.5-63) vs. 41 mmHg (40-45), p = 0.07, that remained higher at 48 h: 54 mmHg (43-58.7) vs. 41 (38.5-45.5), p = 0.03). In 12 patients (5 COVID-19 and 7 non-COVID-19), AHRF evolved to pediatric acute respiratory distress syndrome (PARDS). All non-COVID-19 patients had severe PARDS, while 3 out of 5 patients in the COVID-19 group had mild or moderate PARDS. Overall Pediatric Intensive Care Medicine (PICU) mortality was 14.3%.
Conclusions: Children with AHRF due to SARS-CoV2 infection had fewer comorbidities and better oxygenation than patients with non-COVID-19 AHRF. In this study, progression to severe PARDS was rarely observed in children with COVID-19.

Keywords: acute hypoxemic respiratory failure; acute respiratory distress syndrome; children; coronavirus disease 2019; mechanical ventilation.