Acute respiratory distress syndrome in children with lower respiratory tract infection requiring invasive mechanical ventilation: post hoc analysis of the 2019-2020 bronchiolitis and codetection cohort

Benjamin R. White; Lee Polikoff; Robin Alexander; Benjamin R. Baer; Alexandre T. Rotta; Sebastián González-Dambrauskas; Ledys M. Izquierdo; Pablo Castellani; Christopher M. Watson; Ryan A. Nofziger; Steven Pon; Todd Karsies; Steven L. Shein; Bronchiolitis And COdetectioN (BACON) Study Investigators; Bronchiolitis Subgroup of the Pediatric Acute Lung Injury; Sepsis Investigators Network; Red Colaborativa Pediátrica de Latinoamérica Network

doi:10.1097/PCC.0000000000003712

Acute respiratory distress syndrome in children with lower respiratory tract infection requiring invasive mechanical ventilation: post hoc analysis of the 2019-2020 bronchiolitis and codetection cohort

Benjamin R. White^*, Lee Polikoff, Robin Alexander, Benjamin R. Baer, Alexandre T. Rotta, Sebastián González-Dambrauskas, Ledys M. Izquierdo, Pablo Castellani, Christopher M. Watson, Ryan A. Nofziger, Steven Pon, Todd Karsies, Steven L. Shein, Bronchiolitis And COdetectioN (BACON) Study Investigators, Bronchiolitis Subgroup of the Pediatric Acute Lung Injury, Sepsis Investigators Network, Red Colaborativa Pediátrica de Latinoamérica Network

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives:
Bronchiolitis and other lower respiratory tract infections (LRTIs) are the most common causes of pediatric respiratory failure. There is insufficient evidence characterizing pediatric acute respiratory distress syndrome (PARDS) in young children with LRTI to inform clinical management. We aimed to describe the prevalence and clinical characteristics of children intubated for LRTI and meeting PARDS criteria.

Design:

We performed a post hoc analysis of data from the Bronchiolitis And COdetectioN (BACON) study, an international prospective observational study of critical bronchiolitis. We compared PARDS subjects (meeting criteria the first full calendar day following intubation) to non-PARDS subjects.

Setting:

Forty-eight international PICUs recruiting to the BACON study, from December 2019 to November 2020.

Patients:

Children younger than 2 years old, requiring mechanical ventilation for acute LRTI.

Interventions:

None.

Measurements and Main Results:

Complete data were available for 571 children. Day 1 PARDS was diagnosed in 240 subjects(42%) and associated with increased mortality (7.9% vs. 2.7%; p = 0.023), greater duration of invasive ventilation (165 hr [interquartile range, 112–251 hr] vs. 135 hr [76–204 hr]; p < 0.001), and PICU length of stay (11 d [7–16 d] vs. 8 d [5–13 d]; p < 0.001). In our multivariable competing risk model, the presence of PARDS on day 1 was causally related to a prolonged duration of mechanical ventilation with the probability of extubation at 7 days for those with PARDS equal to 49% (44–54%) compared with 64% (59–69%) for those without PARDS.

Conclusions:

PARDS development was common in this critical bronchiolitis cohort, resulted in a longer duration of mechanical ventilation, and was associated with increased mortality and PICU length of stay. Prospective studies are needed to elucidate the optimal management of critical bronchiolitis.

Original language	English
Pages (from-to)	e600-e610
Number of pages	11
Journal	Pediatric Critical Care Medicine
Volume	26
Issue number	5
Early online date	6 Mar 2025
DOIs	https://doi.org/10.1097/PCC.0000000000003712
Publication status	Published - 1 May 2025

Keywords

Acute respiratory distress syndrome
Bronchiolitis
Critical care
Mechanical ventilator
Pediatric

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White, B. R., Polikoff, L., Alexander, R., Baer, B. R., Rotta, A. T., González-Dambrauskas, S., Izquierdo, L. M., Castellani, P., Watson, C. M., Nofziger, R. A., Pon, S., Karsies, T., Shein, S. L., Bronchiolitis And COdetectioN (BACON) Study Investigators, Bronchiolitis Subgroup of the Pediatric Acute Lung Injury, Sepsis Investigators Network, & Red Colaborativa Pediátrica de Latinoamérica Network (2025). Acute respiratory distress syndrome in children with lower respiratory tract infection requiring invasive mechanical ventilation: post hoc analysis of the 2019-2020 bronchiolitis and codetection cohort. Pediatric Critical Care Medicine, 26(5), e600-e610. https://doi.org/10.1097/PCC.0000000000003712

@article{c26c813b7f554a95b8b45d5a06823007,

title = "Acute respiratory distress syndrome in children with lower respiratory tract infection requiring invasive mechanical ventilation: post hoc analysis of the 2019-2020 bronchiolitis and codetection cohort",

abstract = "Objectives: Bronchiolitis and other lower respiratory tract infections (LRTIs) are the most common causes of pediatric respiratory failure. There is insufficient evidence characterizing pediatric acute respiratory distress syndrome (PARDS) in young children with LRTI to inform clinical management. We aimed to describe the prevalence and clinical characteristics of children intubated for LRTI and meeting PARDS criteria. Design: We performed a post hoc analysis of data from the Bronchiolitis And COdetectioN (BACON) study, an international prospective observational study of critical bronchiolitis. We compared PARDS subjects (meeting criteria the first full calendar day following intubation) to non-PARDS subjects. Setting: Forty-eight international PICUs recruiting to the BACON study, from December 2019 to November 2020. Patients: Children younger than 2 years old, requiring mechanical ventilation for acute LRTI. Interventions: None. Measurements and Main Results: Complete data were available for 571 children. Day 1 PARDS was diagnosed in 240 subjects(42\%) and associated with increased mortality (7.9\% vs. 2.7\%; p = 0.023), greater duration of invasive ventilation (165 hr [interquartile range, 112–251 hr] vs. 135 hr [76–204 hr]; p < 0.001), and PICU length of stay (11 d [7–16 d] vs. 8 d [5–13 d]; p < 0.001). In our multivariable competing risk model, the presence of PARDS on day 1 was causally related to a prolonged duration of mechanical ventilation with the probability of extubation at 7 days for those with PARDS equal to 49\% (44–54\%) compared with 64\% (59–69\%) for those without PARDS. Conclusions:PARDS development was common in this critical bronchiolitis cohort, resulted in a longer duration of mechanical ventilation, and was associated with increased mortality and PICU length of stay. Prospective studies are needed to elucidate the optimal management of critical bronchiolitis.",

keywords = "Acute respiratory distress syndrome, Bronchiolitis, Critical care, Mechanical ventilator, Pediatric",

author = "White, \{Benjamin R.\} and Lee Polikoff and Robin Alexander and Baer, \{Benjamin R.\} and Rotta, \{Alexandre T.\} and Sebasti{\'a}n Gonz{\'a}lez-Dambrauskas and Izquierdo, \{Ledys M.\} and Pablo Castellani and Watson, \{Christopher M.\} and Nofziger, \{Ryan A.\} and Steven Pon and Todd Karsies and Shein, \{Steven L.\} and \{Bronchiolitis And COdetectioN (BACON) Study Investigators\} and \{Bronchiolitis Subgroup of the Pediatric Acute Lung Injury\} and \{Sepsis Investigators Network\} and \{Red Colaborativa Pedi{\'a}trica de Latinoam{\'e}rica Network\}",

note = "Funding: Dr. Polikoff received funding from Novavax. Dr. Rotta received funding from Breas US and Elsevier. Dr. Nofziger's institution received funding from the Centers for Disease Control and Prevention and the National Institutes of Health. Dr. Shein received funding from Ceribell.",

year = "2025",

month = may,

day = "1",

doi = "10.1097/PCC.0000000000003712",

language = "English",

volume = "26",

pages = "e600--e610",

journal = "Pediatric Critical Care Medicine",

issn = "1529-7535",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "5",

}

White, BR, Polikoff, L, Alexander, R , Baer, BR, Rotta, AT, González-Dambrauskas, S, Izquierdo, LM, Castellani, P, Watson, CM, Nofziger, RA, Pon, S, Karsies, T, Shein, SL, Bronchiolitis And COdetectioN (BACON) Study Investigators, Bronchiolitis Subgroup of the Pediatric Acute Lung Injury, Sepsis Investigators Network & Red Colaborativa Pediátrica de Latinoamérica Network 2025, 'Acute respiratory distress syndrome in children with lower respiratory tract infection requiring invasive mechanical ventilation: post hoc analysis of the 2019-2020 bronchiolitis and codetection cohort', Pediatric Critical Care Medicine, vol. 26, no. 5, pp. e600-e610. https://doi.org/10.1097/PCC.0000000000003712

Acute respiratory distress syndrome in children with lower respiratory tract infection requiring invasive mechanical ventilation: post hoc analysis of the 2019-2020 bronchiolitis and codetection cohort. / White, Benjamin R.; Polikoff, Lee; Alexander, Robin et al.
In: Pediatric Critical Care Medicine, Vol. 26, No. 5, 01.05.2025, p. e600-e610.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Acute respiratory distress syndrome in children with lower respiratory tract infection requiring invasive mechanical ventilation

T2 - post hoc analysis of the 2019-2020 bronchiolitis and codetection cohort

AU - White, Benjamin R.

AU - Polikoff, Lee

AU - Alexander, Robin

AU - Baer, Benjamin R.

AU - Rotta, Alexandre T.

AU - González-Dambrauskas, Sebastián

AU - Izquierdo, Ledys M.

AU - Castellani, Pablo

AU - Watson, Christopher M.

AU - Nofziger, Ryan A.

AU - Pon, Steven

AU - Karsies, Todd

AU - Shein, Steven L.

AU - Bronchiolitis And COdetectioN (BACON) Study Investigators

AU - Bronchiolitis Subgroup of the Pediatric Acute Lung Injury

AU - Sepsis Investigators Network

AU - Red Colaborativa Pediátrica de Latinoamérica Network

N1 - Funding: Dr. Polikoff received funding from Novavax. Dr. Rotta received funding from Breas US and Elsevier. Dr. Nofziger's institution received funding from the Centers for Disease Control and Prevention and the National Institutes of Health. Dr. Shein received funding from Ceribell.

PY - 2025/5/1

Y1 - 2025/5/1

N2 - Objectives: Bronchiolitis and other lower respiratory tract infections (LRTIs) are the most common causes of pediatric respiratory failure. There is insufficient evidence characterizing pediatric acute respiratory distress syndrome (PARDS) in young children with LRTI to inform clinical management. We aimed to describe the prevalence and clinical characteristics of children intubated for LRTI and meeting PARDS criteria. Design: We performed a post hoc analysis of data from the Bronchiolitis And COdetectioN (BACON) study, an international prospective observational study of critical bronchiolitis. We compared PARDS subjects (meeting criteria the first full calendar day following intubation) to non-PARDS subjects. Setting: Forty-eight international PICUs recruiting to the BACON study, from December 2019 to November 2020. Patients: Children younger than 2 years old, requiring mechanical ventilation for acute LRTI. Interventions: None. Measurements and Main Results: Complete data were available for 571 children. Day 1 PARDS was diagnosed in 240 subjects(42%) and associated with increased mortality (7.9% vs. 2.7%; p = 0.023), greater duration of invasive ventilation (165 hr [interquartile range, 112–251 hr] vs. 135 hr [76–204 hr]; p < 0.001), and PICU length of stay (11 d [7–16 d] vs. 8 d [5–13 d]; p < 0.001). In our multivariable competing risk model, the presence of PARDS on day 1 was causally related to a prolonged duration of mechanical ventilation with the probability of extubation at 7 days for those with PARDS equal to 49% (44–54%) compared with 64% (59–69%) for those without PARDS. Conclusions:PARDS development was common in this critical bronchiolitis cohort, resulted in a longer duration of mechanical ventilation, and was associated with increased mortality and PICU length of stay. Prospective studies are needed to elucidate the optimal management of critical bronchiolitis.

AB - Objectives: Bronchiolitis and other lower respiratory tract infections (LRTIs) are the most common causes of pediatric respiratory failure. There is insufficient evidence characterizing pediatric acute respiratory distress syndrome (PARDS) in young children with LRTI to inform clinical management. We aimed to describe the prevalence and clinical characteristics of children intubated for LRTI and meeting PARDS criteria. Design: We performed a post hoc analysis of data from the Bronchiolitis And COdetectioN (BACON) study, an international prospective observational study of critical bronchiolitis. We compared PARDS subjects (meeting criteria the first full calendar day following intubation) to non-PARDS subjects. Setting: Forty-eight international PICUs recruiting to the BACON study, from December 2019 to November 2020. Patients: Children younger than 2 years old, requiring mechanical ventilation for acute LRTI. Interventions: None. Measurements and Main Results: Complete data were available for 571 children. Day 1 PARDS was diagnosed in 240 subjects(42%) and associated with increased mortality (7.9% vs. 2.7%; p = 0.023), greater duration of invasive ventilation (165 hr [interquartile range, 112–251 hr] vs. 135 hr [76–204 hr]; p < 0.001), and PICU length of stay (11 d [7–16 d] vs. 8 d [5–13 d]; p < 0.001). In our multivariable competing risk model, the presence of PARDS on day 1 was causally related to a prolonged duration of mechanical ventilation with the probability of extubation at 7 days for those with PARDS equal to 49% (44–54%) compared with 64% (59–69%) for those without PARDS. Conclusions:PARDS development was common in this critical bronchiolitis cohort, resulted in a longer duration of mechanical ventilation, and was associated with increased mortality and PICU length of stay. Prospective studies are needed to elucidate the optimal management of critical bronchiolitis.

KW - Acute respiratory distress syndrome

KW - Bronchiolitis

KW - Critical care

KW - Mechanical ventilator

KW - Pediatric

UR - https://www.scopus.com/pages/publications/105000798540

U2 - 10.1097/PCC.0000000000003712

DO - 10.1097/PCC.0000000000003712

M3 - Article

C2 - 40047495

AN - SCOPUS:105000798540

SN - 1529-7535

VL - 26

SP - e600-e610

JO - Pediatric Critical Care Medicine

JF - Pediatric Critical Care Medicine

IS - 5

ER -

White BR, Polikoff L, Alexander R , Baer BR, Rotta AT, González-Dambrauskas S et al. Acute respiratory distress syndrome in children with lower respiratory tract infection requiring invasive mechanical ventilation: post hoc analysis of the 2019-2020 bronchiolitis and codetection cohort. Pediatric Critical Care Medicine. 2025 May 1;26(5):e600-e610. Epub 2025 Mar 6. doi: 10.1097/PCC.0000000000003712

Acute respiratory distress syndrome in children with lower respiratory tract infection requiring invasive mechanical ventilation: post hoc analysis of the 2019-2020 bronchiolitis and codetection cohort

Abstract

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