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Critérios de PALICC no diagnóstico de doentes com SDRA : um estudo epidemiológico retrospetivo na unidade de cuidados intensivos pediátricos do Hospital de Santa Maria
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O Síndrome de Dificuldade Respiratória Aguda (SDRA) inicialmente descrito em 1967, representa um desafio do ponto de vista diagnóstico e, na idade adulta, o gold standart continuam a ser os critérios de Berlim definidos em 2012.
O desafio é ainda maior em idade pediátrica; recentemente, em 2016, para atender às particularidades desta faixa etária, foram criados os critérios PALICC. Desde então, múltiplos estudos dedicaram-se a testar a sua utilidade e comparar a sensibilidade e especificidade com as dos critérios de Berlim, entre os quais o PARDIE foi o de maior magnitude.
Métodos: Estudo retrospetivo epidemiológico da amostra de doentes diagnosticados com PARDS na UCIPed do CHULN entre 2010 e 2022; verificação do cumprimento dos critérios PALICC e comparação com o dia de diagnóstico assumido pela Unidade.
Resultados: Dos 5119 doentes internados no período de estudo, em 43 (0,84%) foi assumido o diagnóstico de PARDS. O insulto inicial precipitante mais prevalente foi “infeção pulmonar primária” (65,85%), seguido de “sépsis” (9,76%). A maior parte tinham comorbilidades (53,7%). 23/29 (79,3%) doentes apresentavam PARDS grave no dia do diagnóstico. 10 (23,3%) não sobreviveram. Todos os doentes cumpriam os critérios de PALICC ao diagnóstico, verificando-se em 13 (40,6%) o seu cumprimento mais precoce, do que o registo do diagnóstico em diário clínico. No geral, os doentes, em média, cumpriam os critérios de PALICC 2,23 dias, antes do dia de diagnóstico considerado pela unidade.
Discussão e conclusão: PARDS continua a ser uma doença que vê o seu diagnóstico reservado para os doentes mais graves. Os critérios de PALICC parecem permitir um diagnóstico mais precoce e numa fase onde os doentes ainda não necessitam de cuidados tão invasivos. A duração do internamento e de ECMO assim como a presença de comorbilidades respiratórias assumem uma relação estatisticamente significativa com maior mortalidade.
Introduction: Acute respiratory distress syndrome was initially described in 1967, and since then its diagnosis has posed some serious obstacles. Although the adult population had its needs met by the Berlin criteria defined in 2012, the pediatric one was left wondering. It was not until 2016 that the PALICC criteria were created to address the specificities of this age group, and since then, multiple studies have aimed to test their utility and compare their sensitivity and specificity with the Berlin criteria, with the PARDIE study being the most significant. Methods: A retrospective epidemiological study of a sample of patients diagnosed with PARDS in the Pediatric Intensive Care Unit (PICU) of CHULN between 2010 and 2022 was conducted. Then it was checked if the sample met the PALICC criteria and when, and compared to the day of the assumed PARDS diagnosis by the unit. Results: Out of the 5119 patients hospitalized during the study period, a diagnosis of PARDS was assumed in 43 cases (0.84%). The most prevalent initial precipitating insult was "primary lung infection" (65.85%), followed by "sepsis" (9.76%). The majority of patients had comorbidities (53.7%). On the day of diagnosis, 23 out of 29 patients (79.3%) had severe PARDS. Among the diagnosed patients, 10 (23.3%) did not survive. All patients in the sample met the PALICC criteria at the time of diagnosis, with 13 cases (40.6%) fulfilling the criteria even before the diagnosis was recorded in the clinical diary. On average, patients met the PALICC criteria 2.23 days prior to the day of diagnosis assumed by the unit. Discussion and Conclusion: PARDS continues to be a disease primarily diagnosed in critically ill patients. The PALICC criteria appear to allow for an earlier diagnosis, at a stage when patients may not yet require invasive treatments. The duration of hospitalization and ECMO, as well as the presence of respiratory comorbidities, were statistically significant factors associated with higher mortality rates.
Introduction: Acute respiratory distress syndrome was initially described in 1967, and since then its diagnosis has posed some serious obstacles. Although the adult population had its needs met by the Berlin criteria defined in 2012, the pediatric one was left wondering. It was not until 2016 that the PALICC criteria were created to address the specificities of this age group, and since then, multiple studies have aimed to test their utility and compare their sensitivity and specificity with the Berlin criteria, with the PARDIE study being the most significant. Methods: A retrospective epidemiological study of a sample of patients diagnosed with PARDS in the Pediatric Intensive Care Unit (PICU) of CHULN between 2010 and 2022 was conducted. Then it was checked if the sample met the PALICC criteria and when, and compared to the day of the assumed PARDS diagnosis by the unit. Results: Out of the 5119 patients hospitalized during the study period, a diagnosis of PARDS was assumed in 43 cases (0.84%). The most prevalent initial precipitating insult was "primary lung infection" (65.85%), followed by "sepsis" (9.76%). The majority of patients had comorbidities (53.7%). On the day of diagnosis, 23 out of 29 patients (79.3%) had severe PARDS. Among the diagnosed patients, 10 (23.3%) did not survive. All patients in the sample met the PALICC criteria at the time of diagnosis, with 13 cases (40.6%) fulfilling the criteria even before the diagnosis was recorded in the clinical diary. On average, patients met the PALICC criteria 2.23 days prior to the day of diagnosis assumed by the unit. Discussion and Conclusion: PARDS continues to be a disease primarily diagnosed in critically ill patients. The PALICC criteria appear to allow for an earlier diagnosis, at a stage when patients may not yet require invasive treatments. The duration of hospitalization and ECMO, as well as the presence of respiratory comorbidities, were statistically significant factors associated with higher mortality rates.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Epidemiologia Pediatric Acute Respiratory Distress Syndrome (PARDS) Berlin Cuidados intensivos pediátricos Pediatric Acute Lung Injury Consensus (PALICC) Pediatria