Zubair Hasan, MD
Assistant Professor
Division of Pulmonary, Critical Care, and Sleep Medicine/Northwell Health, United States
Disclosure information not submitted.
Matthew Taylor, MD
Pediatric Critical Care Attending Physician
Cohen Children's Medical Center
New Hyde Park, New York, United States
Disclosure information not submitted.
Margaret Yang, MD
Resident - Pediatrics
Cohen Children's Medical Center, United States
Disclosure information not submitted.
Alexandra Cummings, DO
Resident - Pediatrics
Cohen Children's Medical Center/Northwell Health, United States
Disclosure information not submitted.
George Mundanchira, MD
Resident - Internal Medicine
Long Island Jewish Medical Center/Northwell Health, United States
Disclosure information not submitted.
Mangala Narasimhan, DO, FCCP, FASM, FACP
Senior Vice President and Director, Critical Care Services
Division of Pulmonary, Critical Care, and Sleep Medicine/Northwell Health, United States
Disclosure information not submitted.
Todd Sweberg, MD
Associate Professor
Cohen Children's Medical Center/Northwell Health, United States
Disclosure information not submitted.
Title: Practice Variation between Medical and Pediatric Intensive Care Units in ARDS Management
Introduction: Acute respiratory distress syndrome (ARDS) and pediatric ARDS (PARDS) have similar pathophysiology but management varies between medical and pediatric intensive care units (MICU, PICU). The aim of this study was to assess practice variations in ARDS management between MICUs and PICUs.
Methods: This was a multi-center retrospective chart review of three tertiary care MICUs and one tertiary care PICU. Charts were identified using billing codes for “acute respiratory distress syndrome”, “pediatric acute respiratory distress syndrome”, and “acute respiratory failure”. Patients aged 12 to 30 admitted to a MICU or PICU who were invasively ventilated for ARDS were included. Age range was chosen to ensure limited variation due to age. ARDS was defined per Berlin (for adults) and PARDIE criteria (for pediatrics).
Results: 67 patients met inclusion criteria, 37 MICU and 30 PICU. Average age was 24.38 years for MICU and 15.37 years for PICU. 27.87% (n=18) of patients had a pre-existing tracheostomy, mostly children (n=13).
The average P/F ratio on presentation was 96.5 for MICU and 105 for PICU (p=0.86). Average oxygenation index was 11.72 for MICU and 11.89 for PICU (p=0.55). MICU patients were more likely to require vasoactive support (p< 0.05). There was no difference in length of stay, duration of mechanical ventilation, or ventilator free days at 28 days.
The majority of patients were managed with conventional ventilation (95.52%, n=64). PICU patients were managed with synchronized intermittent mandatory ventilation (SIMV) (p< 0.01). MICU patients were primarily managed with assist control-volume control (AC/VC) (p< 0.01). PICU patients were more likely extubated to non-invasive ventilation versus supplemental oxygen or room air (p=0.02).
MICU patients were more likely to receive propofol (p< 0.05) and paralysis (p< 0.05). MICU patients were also more likely to have an arterial line (p< 0.01). There was no difference in central venous line (CVL) use (p=0.12).
Conclusions: Despite similar pathophysiology, ARDS management differs between MICUs and PICUs. Adult patients tend to be managed with AC/VC, invasive monitoring, propofol, and paralysis. Pediatric patients are more likely to be exposed to SIMV modes and extubate to non-invasive support. These differences warrant further study to identify best practice.