Pathogen screening and prognostic factors in children with severe ARDS of pulmonary origin |
| |
| Authors: | Thuy Thi Bich Phung PhD Tadaki Suzuki MD PhD Phuc Huu Phan MD PhD Shoji Kawachi MD PhD Hiroyuki Furuya MD PhD Huong Thu Do MSc Tsutomu Kageyama PhD Tuan Anh Ta MD PhD Nam Huu Dao MD Hiroyuki Nunoi MD PhD Dien Minh Tran MD PhD Hai Thanh Le MD PhD Noriko Nakajima MD PhD |
| |
| Affiliation: | 1. Department of Research of Biomolecular for Infectious Disease, Vietnam National Children's Hospital, Hanoi, Vietnam;2. Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan;3. Department of Pediatrics Intensive Care Unit, Vietanm National Children's Hospital, Hanoi, Vietnam;4. Department of Anesthesiology and Intensive Care, National Center for Global Health and Medicine, Tokyo, Japan;5. Department of Preventive Medicine, Tokai University School of Medicine, Center for Molecular Prevention and Environmental Medicine, Isehara, Japan;6. Influenza Virus Research Center, National Institute of Infectious Diseases, Tokyo, Japan;7. Faculty of Medicine, Division of Pediatrics, Department of Developmental and Urinological‐Reproductive Medicine, University of Miyazaki, Miyazaki, Japan;8. Department of Surgeon Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam;9. Department of Emergency, Vietnam National Children's Hospital, Hanoi, Vietnam |
| |
| Abstract: | Background Acute respiratory distress syndrome (ARDS) is one of the most lethal diseases encountered in the pediatric intensive care unit (PICU). The etiological pathogens and prognostic factors of severe ARDS of pulmonary origin in children with respiratory virus infections were prospectively investigated. Methods Enrolled children fulfilled the following criteria: (1) PICU admission; (2) age of 1 month to 16 years; (3) diagnosis of infectious pneumonia and respiratory virus infection; and (4) development of severe ARDS within 72 h after PICU admission. Pathogens were detected in the blood and tracheal lavage fluid using molecular techniques and a conventional culture system. The serum levels of inflammatory mediators on the day of PICU admission were examined. Results Fifty‐seven patients (32 boys; median age, 9 months) were enrolled. Multiple virus infections, co‐infection with bacteria/fungus, and bacteremia/fungemia were observed in 60%, 49%, and 32% of children, respectively. Adenovirus‐B, measles virus, and cytomegalovirus were detected predominantly in tracheal lavage fluid. There were no statistically significant differences between non‐survivors and survivors regarding the types of pathogen, incidence of multiple virus infection, gender, age, clinical features, and treatment. The serum levels of interferon (IFN)‐γ and the IFN‐γ/interleukin (IL)‐10 ratio were higher in non‐survivors. Conclusions IFN‐γ upregulation as detected on the day of PICU admission was found to be one of the possible prognostic factors affecting a fatal outcome. These results suggest that modulation of inflammatory responses is critical for the clinical management of children with ARDS. |
| |
| Keywords: | critical care IFN‐γ pneumonia respiratory virus infection |
|
|
