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Predictors of outcome for children requiring respiratory extra-corporeal life support: implications for inclusion and exclusion criteria.

Abstract：

OBJECTIVES:A range of children receive extra-corporeal life support (ECLS) for respiratory failure, but there is little published data on this group. Our aims were: (1) to analyse predictors of outcome and (2) comment on inclusion and exclusion criteria. DESIGN:Retrospective review. SETTING:Tertiary ECLS centre. PATIENTS:A total of 124 children categorised as 'paediatric respiratory ECLS' from July 1992 to December 2005. RESULTS:Fifty-three percent of children had one or more co-morbid conditions; the median age was 10.1 (IQR 3-34) months; the median ECLS duration was 9 (IQR 5-17) days; survival to discharge was 62% and at 1 year was 59%. Although survival varied according to primary reason for ECLS (range 36-100%), after adjustment for this, the presence of a co-morbid condition was unrelated to mortality (OR = 1.49, 95% CI 0.65, 3.42, P = 0.34) Predictors of mortality were increased pre-ECLS oxygenation index (OR = 1.09, 95% CI 1.00, 1.18, P = 0.05) and shock (OR 2.53, 95% CI 1.21, 5.28, P = 0.01). The relationship between mortality and end organ dysfunction (OR 2.12, 95% CI 0.89, 5.02, P = 0.09) and greater number of pre-ECLS ventilator days (OR 1.10, 95% CI 0.99, 1.22, P = 0.08) was less conclusive. CONCLUSIONS:Pre-existing co-morbid conditions may predispose children to develop severe respiratory failure but with careful case selection, do not appear to reduce the chance of survival. Severity of pulmonary dysfunction determined by OI and shock were key predictors of outcome and should remain important determinants of referral for ECLS.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Pathan N,Ridout DA,Smith E,Goldman AP,Brown KL

doi

10.1007/s00134-008-1232-3

subject

Has Abstract

pub_date

2008-12-01 00:00:00

pages

2256-63

issue

12

eissn

0342-4642

issn

1432-1238

journal_volume

34

pub_type

杂志文章

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