title: Epidemiology of pediatric acute respiratory distress syndrome in singapore: risk factors and predictive respiratory indices for mortality.
abstract: OBJECTIVE
  Acute respiratory distress syndrome (ARDS) represents the most severe form of acute lung injury. The aim of our study is to describe the epidemiology of pediatric ARDS in Singapore and compare the outcomes of ARDS using the following respiratory indices: PaO2/FiO2 ratio (P/F ratio), SpO2/FiO2 ratio (S/F ratio), oxygenation index (OI), and oxygen saturation index (OSI).
  
  
  METHODS
  We examined medical records of patients admitted to the Children's Intensive Care Unit in KK Women's and Children's Hospital from 2009 to 2012. Those who fulfilled criteria for the American-European Consensus Conference definition for ARDS were identified. Demographic, clinical, and radiographic information were extracted and analyzed.
  
  
  RESULTS
  We identified 70 patients with ARDS. Median age (interquartile range) was 6.2 (1.4, 10.4) years. The most common risk factor was pneumonia [50 (71%)]. Overall mortality was 44 (63%) patients. Thirty-two (56%) patients had an underlying chronic comorbidity; 18 (46%) were hematology-oncology conditions. Fifty-six (80%) patients had multiorgan dysfunction. Adjunct therapies used in our patients included inhaled nitric oxide [5 (7%)], prone position [22 (31%)], steroids [26 (37%)], and neuromuscular blockade [26 (37%)]. A high OI and low PF ratio after 24 h of diagnosis of ARDS were associated with mortality. From day 3 onward, all four respiratory indices appropriately differentiated survivors from non-survivors. Severity based on the S/F ratio and OSI demonstrated association with decreased ventilator free days and ICU free days.
  
  
  CONCLUSIONS
  Risk factors for mortality included having an underlying comorbidity, multiorgan dysfunction, a low PF ratio, and high OI at 24 h of ARDS. Abnormal SpO2-based measurements were reliable markers of poor outcomes in pediatric ARDS.
authors.affiliation: Department of Pediatric Medicine, KK Women's and Children's Hospital , Singapore , Singapore.
authors.forename: Judith Ju-Ming
authors.initials: JJ
authors.lastname: Wong
authors.affiliation: Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital , Singapore , Singapore ; Duke-NUS Graduate School of Medicine , Singapore , Singapore.
authors.forename: Tsee Foong
authors.initials: TF
authors.lastname: Loh
authors.affiliation: Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo , São Paulo , Brazil.
authors.forename: Daniela
authors.initials: D
authors.lastname: Testoni
authors.affiliation: Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital , Singapore , Singapore.
authors.forename: Joo Guan
authors.initials: JG
authors.lastname: Yeo
authors.affiliation: Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital , Singapore , Singapore.
authors.forename: Yee Hui
authors.initials: YH
authors.lastname: Mok
authors.affiliation: Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital , Singapore , Singapore ; Duke-NUS Graduate School of Medicine , Singapore , Singapore.
authors.forename: Jan Hau
authors.initials: JH
authors.lastname: Lee
keywords: Asia; acute lung injury; acute respiratory distress syndrome; children; critical care; epidemiology; pediatric intensive care unit; pulse oximetry