Nadir Yehya, MD, MSCE
Children's Hospital of Philadelphia
Cherry Hill, NJ
Disclosure information not submitted.
Garrett Keim, MD (he/him/his)
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Title: Lung Function and Pulmonary Clinic Utilization after Pediatric Acute Respiratory Distress Syndrome
Introduction: Most children who meet criteria for Pediatric acute respiratory distress syndrome (PARDS) survive to discharge. However, the long-term pulmonary morbidity in PARDS survivors remains largely unknown. The objective of this study was to describe utilization of pulmonary outpatient follow-up and to characterize pulmonary function (PFT) abnormalities in PARDS survivors.
Methods: A retrospective analysis of a prospective cohort of children meeting Berlin ARDS and PALICC PARDS criteria between July 2013 and June 2019, was performed. Evaluable PFTs meeting ATS criteria were included. Non-parametric statistics were used to assess the association between clinical variables at index PARDS diagnosis and use of pulmonary follow-up and with PFTs.
Results: Of 400 PARDS survivors, 172 (43.0%) attended a pulmonary clinic visit. Median time to follow up was 135 days (IQR: 65-285). 52.9% (90/172) had mild, 34.1% (58/172) had moderate, 51.2% (22/172) had severe PARDS. Nearly half (51.2%, 88/172) of patients in pulmonary clinic had established care with pulmonary prior to PARDS. There were 34 children with evaluable PFTs during the first year after PARDS, of which 64.7% (22/34) were abnormal, with restrictive pattern being most common (44.1%, 15/34), followed by obstructive (29.4%, 10/34), and then mixed restrictive and obstructive (8.8%, 3/34). Half of children (50%, 11/22) with PFT abnormalities were not ordered for pulmonary follow-up at discharge. Among children with PFT abnormalities, median age was significantly higher (6.8 vs 14.5 years old, p=0.002). There was no significant difference in PARDS severity at 24h of diagnosis (p=0.37) or ventilator days (p=0.44) among those with or without abnormal PFTs, although we were underpowered for any definitive conclusions.
Conclusions: Of children who had PFTs after PARDS, abnormalities were common. Half of the children with PFT abnormalities were not ordered for pulmonary follow-up at hospital discharge. Pulmonary follow-up should be encouraged in survivors of PARDS regardless of severity.