Acute lung injury in pediatric intensive care in Australia and New Zealand: a prospective, multicenter, observational study.
OBJECTIVE
Acute lung injury (ALI) is poorly defined in children. The objective of this prospective study was to clarify the incidence, demographics, management strategies, outcome, and mortality predictors of ALI in children in Australia and New Zealand.


METHODS
Multicenter prospective study during a 12-month period.


METHODS
Intensive care unit.


METHODS
All children admitted to intensive care and requiring mechanical ventilation were screened daily for development of ALI based on American-European Consensus Conference guidelines. Identified patients were followed for 28 days or until death or discharge.


METHODS
None.


RESULTS
There were 117 cases of ALI during the study period, giving a population incidence of 2.95/100,000 <16 yrs. ALI accounted for 2.2% of pediatric intensive care unit admissions. Mortality was 35% for ALI, and this accounted for 30% of all pediatric intensive care unit deaths during the study period. Significant preadmission risk factors for mortality were chronic disease, older age, and immunosuppression. Predictors of mortality during admission were ventilatory requirements (peak inspiratory pressures, mean airway pressure, positive end-expiratory pressure) and indexes of respiratory severity on day 1 (Pao2/Fio2 ratio and oxygenation index). Higher maximum and median tidal volumes were associated with reduced mortality, even when corrected for severity of lung disease. Development of single and multiple organ failure was significantly associated with mortality.


CONCLUSIONS
ALI in children is uncommon but has a high mortality rate. Risk factors for mortality are easily identified. Ventilatory variables and indexes of lung severity were significantly associated with mortality.
Erickson
Simon
S
Pediatric Intensive Care Units at Princess Margaret Hospital for Children, Perth, WA, Australia. simon.erickson@health.wa.gov.au
Schibler
Andreas
A
Numa
Andrew
A
Nuthall
Gabrielle
G
Yung
Michael
M
Pascoe
Elaine
E
Wilkins
Barry
B
D000293:Adolescent; D000367:Age Factors; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003710:Demography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D011446:Prospective Studies; D012372:ROC Curve; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000453:epidemiology* / Q000401:mortality; D012129:Respiratory Function Tests; D012307:Risk Factors