Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. 87-95 (doi:10.1542/peds.2007-2462)
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ARTICLE

Incidence and Outcomes of Pediatric Acute Lung Injury

Jerry J. Zimmerman, MD, PhDa, Saadia R. Akhtar, MDb, Ellen Caldwell, MSc and Gordon D. Rubenfeld, MD, MScd

a Division of Pediatric Critical Care Medicine, Seattle Children's Hospital
c Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, Washington
b Idaho Pulmonary Associates, Boise, Idaho
d Program in Trauma, Emergency, and Critical Care, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

OBJECTIVE: This population-based, prospective, cohort study was designed to determine the population incidence and outcomes of pediatric acute lung injury.

METHODS: Between 1999 and 2000, 1 year of screening was performed at all hospitals admitting critically ill children in King County, Washington. County residents 0.5 to 15 years of age who required invasive (through endotracheal tube or tracheostomy) or noninvasive (through full face mask) mechanical ventilation, regardless of the duration of mechanical ventilation, were screened. From this population, children meeting North American-European Consensus Conference acute lung injury criteria were eligible for enrollment. Postoperative patients who received mechanical ventilation for <24 hours were excluded. Data collected included the presence of predefined cardiac conditions, demographic and physiological data, duration of mechanical ventilation, and deaths. US Census population figures were used to estimate incidence. Associations between outcomes and subgroups identified a priori were assessed.

RESULTS: Thirty-nine children met the criteria for acute lung injury, resulting in a calculated incidence of 12.8 cases per 100000 person-years. Severe sepsis (with pneumonia as the infection focus) was the most common risk factor. The median 24-hour Pediatric Risk of Mortality III score was 9.0, and the mean ± SD was 11.7 ± 7.5. The hospital mortality rate was 18%, lower than that reported previously for pediatric acute lung injury. There were no statistically significant associations between age, gender, or risk factors and outcomes.

CONCLUSIONS: We present the first population-based estimate of pediatric acute lung injury incidence in the United States. Population incidence and mortality rates are lower than those for adult acute lung injury. Low mortality rates in pediatric acute lung injury may necessitate clinical trial outcome measures other than death.

Key Words: acute respiratory distress syndrome • acute lung injury • epidemiology • children • incidence • mortality rate • mechanical ventilation

Abbreviations: ALI—acute lung injury • ARDS—acute respiratory distress syndrome • IQR—interquartile range • KCLIP—King County Lung Injury Project • MV—mechanical ventilation • NAECC—North American-European Consensus Conference • PRISM III—Pediatric Risk of Mortality III • FIO2—fraction of inspired oxygen

Accepted Dec 26, 2008.


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Pediatrics Online, 26 Aug 2009 [Full text]