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INTRODUCTION@#Evidence supporting non-invasive ventilation (NIV) in paediatric acute respiratory distress syndrome (PARDS) remains sparse. We aimed to describe characteristics of patients with PARDS supported with NIV and risk factors for NIV failure.@*MATERIALS AND METHODS@#This is a multicentre retrospective study. Only patients supported on NIV with PARDS were included. Data on epidemiology and clinical outcomes were collected. Primary outcome was NIV failure which was defined as escalation to invasive mechanical ventilation within the first 7 days of PARDS. Patients in the NIV success and failure groups were compared.@*RESULTS@#There were 303 patients with PARDS; 53/303 (17.5%) patients were supported with NIV. The median age was 50.7 (interquartile range: 15.7-111.9) months. The Paediatric Logistic Organ Dysfunction score and oxygen saturation/fraction of inspired oxygen (SF) ratio were 2.0 (1.0-10.0) and 155.0 (119.4- 187.3), respectively. Indications for NIV use were increased work of breathing (26/53 [49.1%]) and hypoxia (22/53 [41.5%]). Overall NIV failure rate was 77.4% (41/53). All patients with sepsis who developed PARDS experienced NIV failure. NIV failure was associated with an increased median paediatric intensive care unit stay (15.0 [9.5-26.5] vs 4.5 [3.0-6.8] days; <0.001) and hospital length of stay (26.0 [17.0-39.0] days vs 10.5 [5.5-22.3] days; = 0.004). Overall mortality rate was 32.1% (17/53).@*CONCLUSION@#The use of NIV in children with PARDS was associated with high failure rate. As such, future studies should examine the optimal selection criteria for NIV use in these children.
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INTRODUCTION@#Growing evidence suggests there is potential harm associated with excess fluid in critically ill children. This study aimed to evaluate the association between percentage fluid overload (%FO) and paediatric intensive care unit (PICU) mortality in children with severe sepsis and septic shock.@*MATERIALS AND METHODS@#Patients with severe sepsis and septic shock admitted to the PICU were identified through discharge codes. Data on clinical characteristics, fluid input and output were collected. %FO was calculated as: (total daily input - total daily output [L]/admission body weight [kg]) × 100. The primary outcome was PICU mortality. Secondary outcomes were 28-day ventilator-free days (VFD), intensive care unit-free days (IFD) and inotrope-free days (InoFD). Multivariate analysis adjusting for presence of comorbidities, Pediatric Index of Mortality (PIM) 2 score and multiorgan dysfunction were used to determine the association between cumulative %FO over 5 days and outcomes.@*RESULTS@#A total of 116 patients were identified, with a mortality rate of 28.4% (33/116). Overall median age was 105.9 (23.1-157.2) months. Cumulative %FO over 5 days was higher in non-survivors compared to survivors (median [interquartile range], 15.1 [6.3-27.1] vs 3.6 [0.7-11.1]%; <0.001). Cumulative %FO was associated with increased mortality (adjusted odds ratio 1.08, 95% confidence interval 1.03-1.13; = 0.001) and decreased VFD, IFD and InoFD (adjusted mean difference -0.37 [-0.53 - -0.21] days, -0.34 [-0.49 - -0.20] days, and -0.31 [-0.48 - -0.14] days, respectively).@*CONCLUSION@#Cumulative %FO within the first 5 days of PICU stay was consistently and independently associated with poor clinical outcomes in children with severe sepsis and septic shock. Future studies are needed to test the impact of restrictive fluid strategies in these children.
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<p><b>INTRODUCTION</b>The Paediatric Index of Mortality 3 (PIM 3) and Paediatric Logistic Organ Dysfunction 2 (PELOD 2) scores were recently revised. We aimed to assess the performance of these scores in a contemporary cohort of critically ill children.</p><p><b>MATERIALS AND METHODS</b>This is a single-centre prospective study conducted in a multidisciplinary paediatric intensive care unit (PICU). Consecutive PICU admissions over 1 year were included and admission PIM 3 and PELOD 2 scores were calculated. The performance of each of the scores was evaluated by calculating the area under the curve (AUC) of the receiver operating characteristic (ROC) and the Hosmer-Lemeshow goodness-of-fit test for the outcome of PICU mortality.</p><p><b>RESULTS</b>A total of 570 patient admissions were eligible for this study. The median age of patients was 3.1 (interquartile range [IQR]: 0.4, 8.9 years). Overall median PIM 3 and PELOD 2 scores were 1.2 (IQR: 0.4, 3.2) % and 4 (IQR: 2, 7), respectively. The overall mortality rate was 35/570 (6.1%). The PIM 3 and PELOD 2 scores had good discrimination for mortality (AUCs 0.88 [95% confidence interval (CI) 0.85, 0.91] and 0.86 [95% CI 0.83, 0.89], respectively). Goodness-of-fit was satisfactory for both scores. Higher PIM 3 and PELOD 2 scores were also associated with decreasing ventilator and PICU-free days.</p><p><b>CONCLUSION</b>PIM 3 and PELOD 2 scores are robust severity of illness scores that are generalisable to a contemporary cohort of critically ill children in Singapore.</p>