TOP 45 - Pediatric Acute Respiratory Distress Syndrome in the Acute Care Setting

Publication Number: 2797.TOP 45

Sherilyn Salefsky, University of Virginia School of Medicine, Charlottesville, VA, United States; Michael Spaeder, University of Virginia School of Medicine, Charlottesville, VA, United States; Sherry Kausch, University of Virginia, Charlottesville, VA, United States; Andrea Garrod, University of Virginia School of Medicine, Charlottesville, VA, United States

Background: In 2023, the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) published updated guidelines regarding Pediatric Acute Respiratory Distress Syndrome (PARDS). With these guidelines came expanded criteria for “Possible PARDS” and “At-risk for PARDS.” While there is a fair amount of literature regarding the incidence/prevalence of PARDS and risk factors for developing this critical illness, there is limited data with respect to patients that have Possible PARDS or those who are At-Risk for PARDS.

Objective: The primary aim of this study is to determine the prevalence of Possible PARDS or At-Risk for PARDS in the acute care setting of a tertiary level hospital from January 2021 until June 2024. The secondary aim is to assess for specific risk factors in patients with Possible PARDS or At-Risk for PARDS that are associated with required escalation of care setting or escalation of respiratory support.

Design/Methods: In this retrospective single center study, charts from January 2021 through June 2024 were reviewed for all pediatric patients in the acute care setting who required High Flow Nasal Cannula (HFNC) for respiratory support (n=569). The study was deemed Institutional Review Board Exempt in October 2024. Charts were then excluded if patients were in the neonatal period or > 18 years old. Other exclusion factors include initial admission directly to intensive care unit or known cyanotic heart disease. Of the 270 patients that met inclusion criteria, data was collected regarding age, sex, saturation to faction of inspired oxygen ratio (SpO2/FiO2 ratio) at time of admission, SpO2/FiO2 ratio nadir during hospitalization and SpO2/FiO2 ratio at time of escalation of care, infection status, chest radiography findings and all clinical diagnoses from current admission. Escalation of care was defined in this study as the time at which a rapid response was called, transfer to intermediate care unit or intensive care unit or escalation to non-invasive positive pressure ventilation (NIPPV). To address the primary aim, patients were retrospectively categorized as meeting criteria for PARDS, Possible PARDS, At-Risk for PARDS or none of the above. In the next month, data analysis will be completed from the data collected to address the secondary aim. The Wilcoxon rank-sum test will be used to evaluate continuous variables including age and SpO2/FiO2 ratios while Chi-squared test will be used to evaluate categorical factors including sex, infectious status and other clinical diagnoses.