(1204) Acute Respiratory Distress Syndrome in Adolescents and Young Adults: A Multi-Hospital Cohort Study

Sunday, February 23, 2025

12:15pm – 1:15pm Eastern Time

Location: Connections Central - RST 16

First Author(s)

DS

Danielle Severns, MD (she/her/hers)

Indiana University School of Medicine, Riley Hospital for Children
Indiana University at Riley Hospital for Children, United States

Co-Author(s)

Samer Abu-Sultaneh, MD, FCCM

Riley Hospital For Children at Indiana University Health
Indianapolis, Indiana, USA
Daniel T. Cater, MD (he/him/his)

Indiana University School of Medicine, Riley Hospital for Children
Indianapolis, Indiana, USA
GB

Gabriel Bosslet, MD

Assistant Dean for Faculty Affairs and Professional Development, Professor of Clinical Medicine
Indiana University, United States
LC

Lauren Castaneda, MD

Assistant Professor of Clinical Pediatrics
Riley Hospital for Children at Indiana University Health, United States
Courtney Rowan, MD

Riley Hospital For Children at Indiana University Health
Indianapolis, USA

Introduction: Adult and pediatric acute respiratory distress syndrome (ARDS) guidelines differ, leaving uncertainty for the diagnosis and management of ARDS in adolescents and young adults (AYA). We sought to describe the differences in pediatric acute lung injury consensus conference-2 (PALICC-2) and Berlin definitions, ARDS management, and outcomes of AYAs at a pediatric ICU (PICU) versus adult ICUs.

Methods: This is a retrospective cohort study of AYAs, aged 15-25 years, admitted to the ICU in a pediatric hospital or two adult hospitals in 2023. Intubated AYAs were screened for PALICC-2 and Berlin criteria. ARDS therapies were examined in the first 72 hours after ARDS diagnosis.

Results: Seventy-five AYAs were included with 33 (44%) admitted to the PICU and 42 (56%) to the adult ICUs. AYAs in the PICU were younger (17 [IQR:16, 17] vs. 21 [IQR:19, 24] years, p< 0.001). Admission diagnoses and acuity scores were not different between ICUs. Most, 74 (99%), met PALICC-2 and 30 (40%) met Berlin criteria at diagnosis. Mortality was not different for those who did or did not meet Berlin criteria (p=0.66). If SpO2:FiO2 was replaced for PaO2:FiO2, 84% met Berlin criteria. The PICU had a trend towards more severe ARDS (PALICC-2) (58% vs 38%, p=0.09). AYAs in the PICU had higher median positive end expiratory pressure (10 [IQR:8,12] vs. 8 [IQR:5,10] cmH2O, p=0.003) at diagnosis and 4 hours after diagnosis (p=0.008). More AYAs in the PICU received neuromuscular blockade (33% vs. 7%, p=0.004), nitric oxide (9% vs. 0%, p=0.046), and oscillatory ventilation (9% vs. 0%, p=0.046). Prone positioning, corticosteroid, and ECMO use were similar. More AYAs in adult ICUs received a tracheostomy (29% vs, 9%, p=0.04) and time to tracheostomy was shorter than the PICU (9 [IQR:6, 12] vs 41 [IQR:22, 43] days, p=0.01). More AYAs in the PICU received noninvasive respiratory support (79% vs. 26%, p= < 0.001) post-extubation. There was no difference between pediatric and adult ICUs in mortality (27% vs. 21%, p=0.56), duration of ventilation (p=0.20), or ICU length of stay (p=0.36).

Conclusions: Most AYAs with ARDS met PALICC-2 criteria, while only 40% met Berlin criteria. While AYAs with ARDS received different ventilator management and ancillary therapies between pediatric and adult ICUs, clinical outcomes were similar.