Nutritional Status and Mechanical Ventilation Practices in Pediatric Acute Respiratory Distress Syndrome: A Secondary Analysis of the 2017–2023 PARDSAsia Study

Abstract

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 Fio<inf>2</inf> 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/Fio<inf>2</inf> combinations were, respectively, –1.7 (–3.3, 0.0) vs. –0.9 (–2.7, 0.0) vs. –0.6 (–1.8, 0.4) cm H<inf>2</inf>O 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.