Mecánica pulmonar en el síndrome de distrés respiratorio agudo pediátrico asociado a COVID-19 aguda y MIS-C

Jesús Domínguez-Rojas, Álvaro Coronado Munoz, Yesica Luna-Delgado, Giancarlo Alvarado-Gamarra, Gaudi Quispe Flores, Patrick Caqui-Vilca, Noé Atamari-Anahui, Cleotilde Mireya Muñoz Ramírez, Mariela Tello-Pezo, Pablo Cruces, Pablo Vásquez-Hoyos, Franco Díaz

Producción científica: Contribución a una revistaArtículorevisión exhaustiva

Resumen

Objective: To describe lung mechanics in Pediatric Acute Respiratory Distress Syndrome (PARDS) associated with acute COVID-19 and MIS-C with respiratory failure. Methods: A concurrent multi-center observational study was performed, analyzing clinical variables and pulmonary mechanics of PARDS associated with COVID-19 in 4 Pediatric intensive care units (PICU) in Peru. The subgroup analysis included PARDS associated with multisystem inflammatory syndrome in children (MIS-C), MIS-PARDS, and PARDS with COVID-19 primary respiratory infection, C-PARDS. In addition, receiver operating characteristic (ROC) curve analysis for mortality and lung mechanics was performed. Results: 30 patients were included. The age was 7.5 (4-11) years, 60% were male, and mortality was 23%. 47% corresponded to MIS-PARDS and 53% to C-PARDS groups. C-PARDS had positive RT-PCR in 67% and MIS-PARDS none (p < 0.001). C-PARDS group had more profound hypoxe-mia (P/F ratio < 100, 86% vs. 38%, p < 0.01) and higher driving-pressure [14(10-22) vs 10(10-12) cmH2O], and lower compliance of the respiratory system (CRS) [0.5 (0.3-0.6) vs 0.7(0.6-0.8) ml/kg/cmH2O] compared with MIS-PARDS (all p < 0.05). The ROC analysis for mortality showed that driving pressure had the best performance [AUC 0.91(95%CI0.81-1.00), with the best cut-off point of 15 cmH2O (100% sensitivity and 87% specificity). Mortality in C-PARDS was 38% and 7% in MIS-PARDS (p = 0.09). MV-free days were 12(0-23) in C-PARDS and 23(21-25) in MIS-PARDS (p = 0.02). Conclusion: Patients with C-PARDS have lung mechanics characteristics similar to classic moderate to severe PARDS. This was not observed in patients with MIS-C. As seen in other studies, a driving pressure ≥ 15 cmH2O was the best discriminator for mortality. These findings may help guide ventilatory management strategies for these two different presentations.

Título traducido de la contribuciónLung mechanics in pediatric acute respiratory distress syndrome associated to acute COVID-19 and MIS-C
Idioma originalEspañol
Páginas (desde-hasta)350-360
Número de páginas11
PublicaciónAndes Pediatrica
Volumen94
N.º3
DOI
EstadoPublicada - 1 may. 2023

Palabras clave

  • COVID-19
  • Driving Pressure
  • MIS-C
  • PARDS
  • Pulmonary Mechanics

Áreas temáticas de ASJC Scopus

  • Pediatría, perinaltología y salud infantil

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