Evaluation of the patients WHO developed acute respiratory distress syndrome at Çukurova University, pediatric intensive care unit

Aim: We aimed to investigate the frequency of Acute Respiratory Distress Syndrome (ARDS) at Çukurova University, Pediatric Intensive Care Unit (PICU) and etiological factors, underlying primary health conditions, mechanic ventilation practice, treatment modalities and mortality rates. Additionally, we aimed to compare oxygenisation criteria used for diagnosis of the patients. Material and Methods: Thirty-tree patients suffered from ARDS in their follow-up between 1 January 2016 - 31 December 2017 at Çukurova University, Pediatric Intensive Care Unit were included to the present study. Results: Mean age at the diagnosis was 78.8 (range, 4-204) months of 33 patients included to the study. Seventeen (51.5%) patients were female and 16 (48.5%) were male. Mean hospitalization duration was 38.1 days, of which a mean of 25.9 days passed in PICU. The mean duration of ventilation from an endotracheal tube was 17 days. Mild, moderate and severe ARDS were found in 10 (30.3%), 15 (45.5%) and 8 (24.2%) of the patients respectively. The origin of ARDS was pulmonary in 26 (78.8%) and non-pulmonary in 7 (21.2%). Correlation was found between Oxygenisation Index and Oxygenisation Saturation Index which were used in disease staging. Thirty-tree (97%) patients were followed on Invasive Mechanical Ventilation (IMV) and remaining one (3%) on Non-invasive Mechanical Ventilation (NIMV). High flow oscillatory ventilation was performed to three (9.1%) patients while 4 (12.1%) undergone Extra-Corporeal Membrane Oxygenisation (ECMO). Four (12.1%) patients developed pneumothorax and 10 (30.3%) suffered from infections of which 7 (21.2%) with ventilator associated pneumonia. One (3%) patient deceased due to multi-organ dysfunction and another one (3%) from refractory hypoxemia. Higher Pediatric Index of Mortality (PIM)-II, Pediatric Risk of Mortality (PRISM)-III and Paediatric Logistic Organ Dysfunction (PELOD) scores were correlated with severe ARDS, besides they cause higher stages of non-pulmonary ARDS (p<0.01). Conclusion: ARDS is still the leading cause of mortality in PICUs. Mechanical ventilation is the most important part of the treatment. It is known that lung protective mechanical ventilation strategies decrease the morbidity and mortality. Use of mechanical ventilation-off treatment modalities are increasing and studies on this topic are ongoing. However, venovenous-ECMO should be considered in severe and refractory pulmonary ARDS treatment. Keywords: Acute Respiratory Distress Syndrome, Child