TY - JOUR
T1 - Nutritional Status and Mechanical Ventilation Practices in Pediatric Acute Respiratory Distress Syndrome
T2 - A Secondary Analysis of the 2017–2023 PARDSAsia Study
AU - Goh, Chen Yun
AU - Leung, Karen Ka Yan
AU - Chong, Jia Yueh
AU - Zhu, Xuemei
AU - Anantasit, Nattachai
AU - Fan, Lijia
AU - Liu, Chunfeng
AU - Ngu, Louise
AU - Hon, Kam Lun Ellis
AU - Lee, Jan Hau
AU - Xu, Wei
AU - Kurosawa, Hiroshi
AU - Wati, Dyah Kanya
AU - Samransamruajkit, Rujipat
AU - Huang, Li
AU - Jayashree, Muralidharan
AU - Chor, Yek Kee
AU - Dang, Hongxing
AU - Gan, Chin Seng
AU - Pon, Kah Min
AU - Tai, Chian Wern
AU - Phan, Phuc Huu
AU - Aoki, Kazunori
AU - Liauw, Felix
AU - Chuah, Soo Lin
AU - Gede, Suparyatha Ida Bagus
AU - Lee, Pei Chuen
AU - Ong, Jacqueline Soo May
AU - Lee, Siew Wah
AU - Ong, Chengsi
AU - Sultana, Rehena
AU - Wong, Judith Ju Ming
N1 - Publisher Copyright:
© 2025 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
PY - 2025/10
Y1 - 2025/10
N2 - OBJECTIVES: – In this non-prespecified secondary analysis of the PARDSAsia (NCT04068038) 2017–2023 dataset, we describe baseline nutrition status of children with pediatric acute respiratory distress syndrome (PARDS) and determine its association with positive end expiratory pressure (PEEP) during ventilation and mortality. We hypothesized that abnormal nutritional status was associated with adverse outcomes. DESIGN: – The dataset included anthropometric and nutritional data, and body mass index (BMI) z scores were obtained using the World Health Organization standards. Underweight is BMI z score less than –1 and overweight is BMI z score greater than +1. PEEP and Fio2 combinations, by the standard grid, in underweight, overweight and normal nutrition groups were compared. Cox proportional hazard regression tested the association between nutrition status and 60-day mortality. SETTING: – Twenty-one PICUs across Asia, 2017–2023. PATIENTS: – PARDSAsia patients met the 2015 International Guidelines for the Diagnosis and Management of PARDS (PALICC) criteria. INTERVENTIONS: – None. MEASUREMENTS AND MAIN RESULTS: – Overall, of 693 PARDSAsia patients, we included 625 cases comprising 261 of 625 (41.8%) underweight, 235 of 625 (37.6%) normal, and 129 of 625 (20.6%) overweight patients. Being underweight compared with normal or overweight status, was associated with younger median (interquartile range) age: respectively, 1.0 (0.3, 3.7) vs. 1.4 (0.5, 4.6) vs. 1.9 (0.7, 8.5) years (p < 0.001). The prescription of PEEP was more conservative in patients who were underweight compared with patients of normal or overweight nutritional status: PEEP/Fio2 combinations were, respectively, –1.7 (–3.3, 0.0) vs. –0.9 (–2.7, 0.0) vs. –0.6 (–1.8, 0.4) cm H2O below recommended grid value (p < 0.001). Underweight nutritional status was associated with greater risk of 60-day mortality (adjusted hazard ratio 1.85 [95% CI, 1.14–3.01]). CONCLUSIONS: – Underweight nutritional status was prevalent among children within the PARDSAsia 2017–2023 dataset and was associated with poor clinical outcomes. The prescription of PEEP was more conservative in underweight patients compared with those with normal or overweight status.
AB - OBJECTIVES: – In this non-prespecified secondary analysis of the PARDSAsia (NCT04068038) 2017–2023 dataset, we describe baseline nutrition status of children with pediatric acute respiratory distress syndrome (PARDS) and determine its association with positive end expiratory pressure (PEEP) during ventilation and mortality. We hypothesized that abnormal nutritional status was associated with adverse outcomes. DESIGN: – The dataset included anthropometric and nutritional data, and body mass index (BMI) z scores were obtained using the World Health Organization standards. Underweight is BMI z score less than –1 and overweight is BMI z score greater than +1. PEEP and Fio2 combinations, by the standard grid, in underweight, overweight and normal nutrition groups were compared. Cox proportional hazard regression tested the association between nutrition status and 60-day mortality. SETTING: – Twenty-one PICUs across Asia, 2017–2023. PATIENTS: – PARDSAsia patients met the 2015 International Guidelines for the Diagnosis and Management of PARDS (PALICC) criteria. INTERVENTIONS: – None. MEASUREMENTS AND MAIN RESULTS: – Overall, of 693 PARDSAsia patients, we included 625 cases comprising 261 of 625 (41.8%) underweight, 235 of 625 (37.6%) normal, and 129 of 625 (20.6%) overweight patients. Being underweight compared with normal or overweight status, was associated with younger median (interquartile range) age: respectively, 1.0 (0.3, 3.7) vs. 1.4 (0.5, 4.6) vs. 1.9 (0.7, 8.5) years (p < 0.001). The prescription of PEEP was more conservative in patients who were underweight compared with patients of normal or overweight nutritional status: PEEP/Fio2 combinations were, respectively, –1.7 (–3.3, 0.0) vs. –0.9 (–2.7, 0.0) vs. –0.6 (–1.8, 0.4) cm H2O below recommended grid value (p < 0.001). Underweight nutritional status was associated with greater risk of 60-day mortality (adjusted hazard ratio 1.85 [95% CI, 1.14–3.01]). CONCLUSIONS: – Underweight nutritional status was prevalent among children within the PARDSAsia 2017–2023 dataset and was associated with poor clinical outcomes. The prescription of PEEP was more conservative in underweight patients compared with those with normal or overweight status.
KW - acute lung injury
KW - artificial ventilation
KW - children
KW - mortality
KW - nutrition status
KW - pediatric intensive care units
UR - https://www.scopus.com/pages/publications/105012993685
U2 - 10.1097/PCC.0000000000003807
DO - 10.1097/PCC.0000000000003807
M3 - Article
AN - SCOPUS:105012993685
SN - 1529-7535
VL - 26
SP - e1242-e1252
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 10
ER -