Disclosure(s): No relevant financial relationship(s) to disclose.
First Author: Niveda Balemurughan, B.S. – University of Southern California Co-Author: Bashira A. Oloso, MS – Biostatistician, Children's Hospital Los Angeles Co-Author: Margaret J. Klein, MS – Senior Statistician, Children's Hospital Los Angeles Co-Author: David A. Baron, MS – Research Associate, Children's Hospital Los Angeles Co-Author: Jeni Kwok, JD – Senior Research Associate, Children's Hospital Los Angeles Co-Author: Jennifer E. Bonilla-Cartagena, BA – Program Specialist, Children's Hospital Los Angeles Co-Author: Robinder Khemani, MD, MS – Childrens Hospital Los Angeles Co-Author: Anoopindar K. Bhalla, MD
Introduction: Children with pediatric acute respiratory distress syndrome (PARDS) are at risk for persistent deficits in functional status and health-related quality of life (HRQL) after critical illness. We aimed to evaluate whether underlying conditions were associated with differences in recovery time in PARDS survivors.
Methods: Secondary analysis of a single-site randomized trial of a lung protective ventilation strategy for PARDS (REDvent R01 134666). Functional Status Scale (FSS) and parent-reported HRQL (PedsQL) were assessed at baseline, ICU discharge, and 1, 2, 4, 6, 12, 18, and 24-months post-ICU. Recovery was defined as return to baseline for FSS and HRQL. Underlying conditions included: Pediatric Cerebral Performance Category >2 (moderate–severe neurocognitive impairment), FSS >6 (any functional impairment), chronic lung disease, and immunosuppression. Multivariable modeling adjusted for age and PARDS severity.
Results: Among 170 ICU survivors, median age was 5.2 years (IQR 1.6–12.4), and median oxygenation index at randomization was 6.9 (IQR 4.6–13.4). At ICU discharge, 43 children (25.3%) had recovered to baseline FSS and 56 children (32.9%) to baseline HRQL. In multivariable models, the only underlying condition associated with recovery at ICU discharge in either FSS or HRQL was that children with chronic lung disease had higher odds of HRQL recovery at discharge (OR 2.1, 95% CI 1.0–4.4, p=0.048).
For children that had not resolved to FSS baseline at ICU discharge, in multivariable modeling a baseline FSS >6 (HR 0.44 [95% CI 0.28–0.71], p< 0.001) or a PCPC >2 (HR 0.57 [95% CI 0.36–0.92], p=0.022) were associated with a slower recovery to FSS baseline in the post-ICU period. Immunosuppression and chronic lung disease were not associated with post-ICU FSS recovery. For children that had not resolved to HRQL baseline at ICU discharge, in multivariable modeling immunosuppression was associated with a slower recovery to HRQL baseline (HR 0.44, 95% CI: 0.24–0.81, p=0.008). Functional impairment, neurocognitive function, and chronic lung disease were not associated with post-ICU HRQL recovery.
Conclusions: Recovery after PARDS varies by underlying conditions. These differences should inform post-ICU care and be considered in designing recovery-focused interventions and clinical trials.
