Evaluation of patients followed for acute respiratory failure in the pediatric intensive care unit

Evaluation of Patients Followed for Acute Respiratory Failure in the Pediatric Intensive Care Unit Objective: Acute respiratory failure is one of the most important reasons for hospitalization in pediatric intensive care units. The primary treatment for acute respiratory failure is oxygen therapy. Some patients respond quickly, while others require mechanical respiratory support. This study aimed to demonstrate the etiology, vital and laboratory findings, blood gas parameters, respiratory support and treatments provided, observed complications, and treatment success in pediatric patients treated for acute respiratory failure in the pediatric intensive care unit. Materials and Methods: The study included 116 patients treated for acute respiratory failure (ARF) at Çukurova University Faculty of Medicine, Pediatric Intensive Care Unit between January 2021 and December 2022. A data collection form was created to prospectively collect information about the patients. The form included demographic characteristics, intensive care mortality scores, underlying chronic diseases causing acute respiratory failure, type of respiratory failure developed, PRESS score in pneumonia patients, mRDAI score in bronchiolitis patients, vital signs during treatment (heart rate, respiratory rate, SpO2, FiO2), SpO2/FiO2 ratio, respiratory oxygenation index (ROXI) and its variability (ROXV), blood gas parameters, administered respiratory support, medical treatments, sedation, muscle relaxant application duration, imaging methods, length of hospital stay, complications, and mortality. Results: A total of 116 patients were included, with a median age of 23 months (mean age 44.6±53.2 months), comprising 51 (44%) females and 65 (56%) males. The rate of acute respiratory failure among hospitalized children was 13.8%. The most common causes of ARF were foreign body aspiration (n=51, 44%) and pneumonia (n=47, 40.5%). Type 1 respiratory failure was identified in the majority of patients (98.3%, n=114). Of the patients, 102 (87.9%) were fed within the first 48 hours. Significant changes were observed in heart rate, respiratory rate, SpO2, SpO2/FiO2, ROXI, and ROX-V from the 1st hour onwards during treatment (p<0.001). According to the findings of invasive and non-invasive (RM, YANKO, NIMV) respiratory support applied to the patients, the cut-off (threshold) values of S/F at hour 0, p-ROXI at hour 0, and p-ROXV at hour 1 values in predicting respiratory support failure were found to be >152; >62.2 and >46.2, respectively. Complications developed in 6 (5.2%) patients during treatment. Seven (6%) patients experienced mortality. Conclusion: Early diagnosis and treatment are extremely important in pediatric patients with acute respiratory failure. Various oxygen delivery methods are applied in these patients. Parameters such as non-invasive and bedside calculated S/F ratio and p-ROXI index are significant in predicting treatment failure, but more comprehensive randomized and controlled studies are needed to determine their reliability and effectiveness. Keywords: Child, Acute respiratory failure, Oxygen, p-ROXI.