Severity and Mortality of Acute Respiratory Failure in Pediatrics: A Prospective Cohort at 2,600 Meters Above Sea Level

Abstract

Abstract Background: Acute respiratory failure (ARF) is the most frequent cause of cardiorespiratory arrest and subsequent death in children worldwide, therefore several efforts have been made to better understand its etiology and risk factors for further progression (1–4). The aim of this study was to calculate mortality and describe associated factors for severity and mortality in children with acute respiratory failure. Methods: The study was conducted within a prospective multicentric cohort that evaluated the natural history of pediatric acute respiratory failure (ARF). For this analysis three primary outcomes were studied: mortality, invasive mechanical ventilation, and pediatric intensive care unit length of stay. Setting: Pediatric emergency, in-hospital, and critical care services in three hospitals in Bogotá, Colombia, from April 2020 to June 2021. Patients: Eligible patients were children older than 1 month and younger than 18 years of age with respiratory difficulty at time of admission. Patients who developed ARF were followed at time of ARF, 48 hours later, at time of admission and at 30 and 60 days after discharge. Measurements and main results: Out of a total of 685 eligible patients, 296 developed ARF for a calculated incidence of ARF of 43.2%. Of the ARF group, ninety patients (30.4%) needed orotracheal intubation, for a mean of 9.57 days of ventilation (interquartile range = 3.00–11.5). Incidence of mortality was 6.1% (n= 18). The associated factors for mortality in ARF were a history of a neurologic comorbidity and a higher fraction of inspired oxygen at ARF diagnosis. For PICU length of stay associated factors were age between 2 and 5 years of age, exposure to smokers, and respiratory comorbidity. Finally, for mechanical ventilation, the risk factors were obesity and being unstable at admission. Conclusions: ARF is a common cause of morbidity and mortality in children. Understanding the factors associated with greater mortality and severity of ARF might allow earlier recognition and initiation of prompt treatment strategies.