Download PDF
J Pediatr Intensive Care
DOI: 10.1055/s-0044-1786394
Original Article

Predictors of Prolonged Mechanical Ventilation in Pediatric Patients with Hemolytic Uremic Syndrome

Rupal T. Bhakta
1   Pediatric Cardiology/Pediatric Critical Care, Arkansas Children's Hospital, Little Rock, Arkansas, United States
,
Clare C. Brown
2   Health Policy and Management Department, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, United States
,
Xiomara Garcia
1   Pediatric Cardiology/Pediatric Critical Care, Arkansas Children's Hospital, Little Rock, Arkansas, United States
,
Rashmitha Dachepally
1   Pediatric Cardiology/Pediatric Critical Care, Arkansas Children's Hospital, Little Rock, Arkansas, United States
3   Pediatric Critical Care, Children's Nebraska, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Parthak Prodhan
1   Pediatric Cardiology/Pediatric Critical Care, Arkansas Children's Hospital, Little Rock, Arkansas, United States
› Author Affiliations Funding The project described was supported by the Translational Research Institute (TRI) through the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) (Award ID: UL1 TR003107). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funder did not participate in the work.
› Further Information
    Permissions and Reprints

Abstract

This study aimed to analyze factors associated with mechanical ventilation (MV) and prolonged MV (≥12 days) in pediatric hemolytic uremic syndrome (HUS) patients. Retrospective multicenter cohort study analyzed data from 3,831 pediatric HUS (age <18 years) patients between 2004 and 2018 from Pediatric Health Information System database. Multivariate logistic regression was used to pinpoint factors associated with MV and prolonged MV. Among 3,831 patients analyzed, 769 (20%) patients required MV, 166 (23.6%) of them were prolonged MV. Factors independently associated with prolonged MV include African American (adjusted odds ratio [aOR]: 1.98, 95% confidence interval [CI]: 1.11–3.54, p = 0.02), children aged between 1 and 5 years (aOR: 7.69, 95% CI: 3.71–15.93, p < 0.001), pneumonia (aOR: 2.54, 95% CI: 1.51–4.25, p < 0.001), pneumothorax (aOR: 2.41, 95% CI: 1.08–5.39, p = 0.032), liver dysfunction (aOR: 3.22, 95% CI: 1.68–6.16, p < 0.001), ileus with perforation (aOR: 1.83, 95% CI: 1.03–3.25, p = 0.039), and sepsis (aOR: 1.97, 95% CI: 1.26–3.08, p = 0.003). In pediatric HUS cases, 20% required MV, and 23.6% of them were prolonged MV. Factors associated with prolong MV include African American race, children aged between 1 and 5 years, pneumonia, pneumothorax, liver dysfunction, ileus with perforation, and sepsis.

Keywords

hemolytic uremic syndrome - children - acute respiratory failure - mechanical ventilation - prolonged MV - outcomes

Supplementary Material



Publication History

Received: 05 October 2023

Accepted: 25 March 2024

Article published online:
30 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Siegler RL. The hemolytic uremic syndrome. Pediatr Clin North Am 1995; 42 (06) 1505-1529
    CrossrefPubMedGoogle Scholar
  • 2 Jorba JM, Martínez-Gutiérrez A, Doménech P, Darnell A, Palomeque A. [Acute edema of the lung as onset of the hemolytic-uremic syndrome]. An Esp Pediatr 1986; 25 (05) 394-396
    PubMedGoogle Scholar
  • 3 Siegler RL, Loghman-Adham M, Timmons OD. Acute respiratory failure in the hemolytic uremic syndrome. Clin Pediatr (Phila) 1995; 34 (12) 660-662
    CrossrefPubMedGoogle Scholar
  • 4 Friedman ML, Nitu ME. Acute respiratory failure in children. Pediatr Ann 2018; 47 (07) e268-e273
    CrossrefPubMedGoogle Scholar
  • 5 Jenssen GR, Vold L, Hovland E, Bangstad HJ, Nygård K, Bjerre A. Clinical features, therapeutic interventions and long-term aspects of hemolytic-uremic syndrome in Norwegian children: a nationwide retrospective study from 1999-2008. BMC Infect Dis 2016; 16: 285
    CrossrefPubMedGoogle Scholar
  • 6 Nathanson S, Kwon T, Elmaleh M. et al. Acute neurological involvement in diarrhea-associated hemolytic uremic syndrome. Clin J Am Soc Nephrol 2010; 5 (07) 1218-1228
    CrossrefPubMedGoogle Scholar
  • 7 Braune SA, Wichmann D, von Heinz MC. et al. Clinical features of critically ill patients with Shiga toxin-induced hemolytic uremic syndrome. Crit Care Med 2013; 41 (07) 1702-1710
    CrossrefPubMedGoogle Scholar
  • 8 Young HL, Brown CC, Crawford B, Blaszak RT, Prodhan P. Streptococcus pneumoniae associated hemolytic uremic syndrome in children. Front Pediatr 2023; 11: 1268971
    CrossrefPubMedGoogle Scholar
  • 9 Waters AM, Kerecuk L, Luk D. et al. Hemolytic uremic syndrome associated with invasive pneumococcal disease: the United Kingdom experience. J Pediatr 2007; 151 (02) 140-144
    CrossrefPubMedGoogle Scholar
  • 10 Geary DF. Hemolytic uremic syndrome and streptococcus pneumoniae: improving our understanding. J Pediatr 2007; 151 (02) 113-114
    CrossrefPubMedGoogle Scholar
  • 11 Agarwal HS, Latifi SQ. Streptococcus pneumoniae-associated hemolytic uremic syndrome in the era of pneumococcal vaccine. Pathogens 2021; 10 (06) 727
    CrossrefPubMedGoogle Scholar
  • 12 Ağbaş A, Göknar N, Akıncı N. et al. Outbreak of Shiga toxin-producing Escherichia-coli-associated hemolytic uremic syndrome in Istanbul in 2015: outcome and experience with eculizumab. Pediatr Nephrol 2018; 33 (12) 2371-2381
    CrossrefPubMedGoogle Scholar
  • 13 Matthies J, Hünseler C, Ehren R. et al. Extrarenal manifestations in Shigatoxin-associated haemolytic uremic syndrome. Klin Padiatr 2016; 228 (04) 181-188
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Gerber A, Karch H, Allerberger F, Verweyen HM, Zimmerhackl LB. Clinical course and the role of shiga toxin-producing Escherichia coli infection in the hemolytic-uremic syndrome in pediatric patients, 1997-2000, in Germany and Austria: a prospective study. J Infect Dis 2002; 186 (04) 493-500
    CrossrefPubMedGoogle Scholar
  • 15 Mody RK, Gu W, Griffin PM. et al. Postdiarrheal hemolytic uremic syndrome in United States children: clinical spectrum and predictors of in-hospital death. J Pediatr 2015; 166 (04) 1022-1029
    CrossrefPubMedGoogle Scholar
  • 16 Salvadori M, Bertoni E. Update on hemolytic uremic syndrome: diagnostic and therapeutic recommendations. World J Nephrol 2013; 2 (03) 56-76
    CrossrefPubMedGoogle Scholar
  • 17 Luna M, Kamariski M, Principi I, Bocanegra V, Vallés PG. Severely ill pediatric patients with Shiga toxin-associated hemolytic uremic syndrome (STEC-HUS) who suffered from multiple organ involvement in the early stage. Pediatr Nephrol 2021; 36 (06) 1499-1509
    CrossrefPubMedGoogle Scholar
  • 18 Khalid M, Andreoli S. Extrarenal manifestations of the hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC HUS). Pediatr Nephrol 2019; 34 (12) 2495-2507
    CrossrefPubMedGoogle Scholar
  • 19 de Buys Roessingh AS, de Lagausie P, Baudoin V, Loirat C, Aigrain Y. Gastrointestinal complications of post-diarrheal hemolytic uremic syndrome. Eur J Pediatr Surg 2007; 17 (05) 328-334
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Liu Y, Wang Q, Hu J. et al. Characteristics and risk factors of children requiring prolonged mechanical ventilation vs. non-prolonged mechanical ventilation in the PICU: a prospective single-center study. Front Pediatr 2022; 10: 830075
    CrossrefPubMedGoogle Scholar
  • 21 Colleti Jr J, Azevedo RT, de Oliveira Caino FR, de Araujo OR. Prolonged mechanical ventilation in children: review of the definition. Pediatr Crit Care Med 2021; 22 (11) e588-e593
    CrossrefPubMedGoogle Scholar
  • 22 Monteverde E, Fernández A, Poterala R. et al. Characterization of pediatric patients receiving prolonged mechanical ventilation. Pediatr Crit Care Med 2011; 12 (06) e287-e291
    CrossrefPubMedGoogle Scholar
  • 23 Payen V, Jouvet P, Lacroix J, Ducruet T, Gauvin F. Risk factors associated with increased length of mechanical ventilation in children. Pediatr Crit Care Med 2012; 13 (02) 152-157
    CrossrefPubMedGoogle Scholar
  • 24 Sauthier M, Rose L, Jouvet P. Pediatric prolonged mechanical ventilation: considerations for definitional criteria. Respir Care 2017; 62 (01) 49-53
    CrossrefPubMedGoogle Scholar