Prevalence and Incidence of Pediatric Acute Respiratory Distress Syndrome in a Tertiary Academic PICU in South Africa

Abstract

Objectives: To determine the prevalence and incidence of pediatric acute respiratory distress syndrome (pARDS) among infants and children admitted to the PICU. Design: A single-center descriptive point prevalence study with twice weekly data collection over a 6 months (August 2020 to February 12, 2021). Setting: Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. Patients: All infants and children admitted to the PICU on study days were included. Interventions: Data were captured electronically on a standardized case record form using a Research Electronic Data Capture electronic database. Measurements and Main Results: The Pediatric Acute Lung Injury Consensus Conference criteria were used to define pARDS cases. Prevalence was calculated as the total number of pARDS cases/1,000 PICU bed days. The study included 354 patients (median [interquartile range]) 10.1 months old (1.5–61.3 mo old), with 204 males (57.6%), who occupied 879 bed days. Of these 879 bed days, 266 (30.3%; 95% CI, 27.2–33.3%) were occupied by pARDS cases, with a calculated prevalence and incidence of 302.6 of 1,000 bed days (30.3%) and 29.7% (95% CI, 26.7–32.7%), respectively. Three cases from the cohort were defined using the oxygen saturation index calculation. In cases receiving invasive ventilation (n = 494; 56.2%), pARDS severity was classified as mild (n = 143; 16.3%), moderate (n = 44; 5.0%), and severe (n = 29, 3.3%). A further 205 beds (23.3%) were occupied by patients classified as being at risk of pARDS. Conclusions: The prevalence and incidence of pARDS in a South African PICU appears substantially higher than findings described in international reports. Further investigation of risk factors and outcomes is warranted.