title: Risk Factors for Mortality and Outcomes in Pediatric Acute Lung Injury/Acute Respiratory Distress Syndrome.
abstract: OBJECTIVE
  Children admitted to PICUs often present with or develop respiratory failure that requires mechanical ventilation. We prospectively identified children admitted to three general PICUs, with the goal of identifying risk factors for mortality.
  
  
  METHODS
  Prospective multicenter observational study.
  
  
  METHODS
  Three general PICUs, two in São Paulo and one in Curitiba, Brazil.
  
  
  METHODS
  Children aged between 1 month and 15 years, consecutively admitted between August 2008 and July 2010, with acute lung injury or acute respiratory distress syndrome that developed at least 12 hours after invasive or noninvasive mechanical ventilation.
  
  
  METHODS
  None.
  
  
  RESULTS
  We used logistic regression models to explore the relationship between death and independent variables. Of 3,046 patients admitted to the three PICUs, 1,658 patients underwent mechanical ventilation, and 84 fulfilled the acute lung injury/acute respiratory distress syndrome inclusion criteria and were analyzed. Nearly 60% were boys, and the median age was 31 months. Pressure control/assist control was the initial mode of mechanical ventilation in 86% of cases, and the median durations of mechanical ventilation and PICU stay were 12 and 15 days, respectively. None of the eight patients with acute lung injury died, whereas 33 of 76 of the remaining patients with acute respiratory distress syndrome died, for an overall mortality rate of 39.3% (95% CI, 28.8-50.6%). In different multivariate logistic regression model, the number of organ dysfunctions at admission, peak inspiratory pressure, airway pressure gradient on day 1, and the mean airway pressure gradient over the first 7 days of mechanical ventilation were significantly associated with mortality.
  
  
  CONCLUSIONS
  Mortality is high in pediatric acute lung injury/acute respiratory distress syndrome. Mechanical ventilation-associated risk factors for death among such patients are potential targets for intervention.
authors.affiliation: 1Pediatric Intensive Care Unit, Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina, São Paulo University Medical School, São Paulo, Brazil. 2Department of Pediatrics, São Paulo University Medical School, São Paulo, Brazil. 3Pediatric Intensive Care Unit, Albert Einstein Hospital, São Paulo, Brazil. 4Pediatric Intensive Care Unit, Federal University of São Paulo (UNIFESP), São Paulo, Brazil. 5Pediatric Intensive Care Unit, Hospital Pequeno Príncipe, Curitiba, Brazil. 6Dendrix Research, São Paulo, Brazil.
authors.forename: Flávia F
authors.initials: FF
authors.lastname: Panico
authors.forename: Eduardo J
authors.initials: EJ
authors.lastname: Troster
authors.forename: Cindy S
authors.initials: CS
authors.lastname: Oliveira
authors.forename: Aline
authors.initials: A
authors.lastname: Faria
authors.forename: Michelle
authors.initials: M
authors.lastname: Lucena
authors.forename: Paulo R D
authors.initials: PR
authors.lastname: João
authors.forename: Everardo D
authors.initials: ED
authors.lastname: Saad
authors.forename: Flávia A K
authors.initials: FA
authors.lastname: Foronda
authors.forename: Artur F
authors.initials: AF
authors.lastname: Delgado
authors.forename: Werther Brunow
authors.initials: WB
authors.lastname: de Carvalho
mesh_terms: D055371:Acute Lung Injury / Q000401:mortality* / Q000628:therapy; D000293:Adolescent; D001784:Blood Gas Analysis; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000401:mortality* / Q000628:therapy; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors