Daily Ards Research Analysis

BACKGROUND: Pediatric acute respiratory distress syndrome (PARDS) causes significant morbidity and mortality, especially in resource-limited settings. This study assessed national hospital and PICU admission rates, regional disparities, and factors associated with mortality in Thai children with PARDS. METHODS: A nationwide retrospective study was conducted using National Health Security Office (NHSO) data from 2015 to 2022. Children aged 1 month to < 18 years with a diagnosis of PARDS (ICD-10-TM code J80) were included. Multivariable logistic regression was used to identify factors associated with mortality, reported as adjusted relative risk (ARR) with 95% confidence intervals (CI). RESULTS: Among 4,241 patients, the prevalence of PARDS ranged from 29.8 to 37.2 per 100,000 hospital admissions, while PICU admission rates ranged from 13.5 to 18.6 per 1,000. Bangkok had the highest rate in 2022 (27.0 per 1,000) but the lowest mortality at 25.6%. The overall mortality rate declined from 53.7% in 2015 to 37.7% in 2022 but remained high in resource-limited regions. Malignancy (ARR 1.29, 95% CI 1.17-1.43 p < 0.001), drowning (ARR 1.43, 95% CI 1.29-1.60, p < 0.001), sepsis and septic shock (ARR 1.19, 95% CI 1.12-1.27, p < 0.001), non-major pulmonary trauma (ARR 1.43, 95% CI 1.16-1.77, p = 0.001), and cardiovascular dysfunction (ARR 1.41, 95% CI 1.32-1.51, p < 0.001) were strongly associated with mortality. Intubation was significantly associated with increased mortality (ARR 2.52, 95% CI 2.12-3.00, p < 0.001), whereas extracorporeal life support was associated with lower mortality (ARR 0.46, 95% CI 0.35-0.61, p < 0.001). CONCLUSIONS: PARDS remains a substantial burden in Thailand, with marked regional differences in access to critical care. Efforts to strengthen healthcare infrastructure and early respiratory support are needed to reduce preventable deaths.

OBJECTIVE: To evaluate the impact of less invasive surfactant (LISA) therapy implementation on short-term clinical outcomes in infants born less than 30 weeks gestational age (GA) in a real-life setting. STUDY DESIGN: This retrospective cohort study included infants born <30 weeks GA between 2009 and 2023 and treated with surfactant. The study period included a pre-LISA epoch (2009-2012), and an epoch when LISA was fully implemented (2018-2023). The primary outcome was death or moderate/severe bronchopulmonary dysplasia (BPD), and its components at 36 weeks postmenstrual age. Outcome data were compared using time trend analysis and multivariable regression analysis adjusting for confounders. RESULTS: Of all the 1502 infants born <30 weeks GA during the study period, 725 infants (48.3%) were included. Of these infants, 189 (26.1%) were born in the pre-LISA epoch, 259 (35.7%) during the LISA implementation period (2013-2017), and 277 (38.2%) in the LISA epoch. Over time, LISA use increased from 0% to 83.0%, while endotracheal tube surfactant decreased from 100% to 47.2%. LISA implementation had no effect on the composite outcome death or BPD (adjusted odds ratio 0.88, 95% CI 0.70, 1.10). The risk of death, but not BPD, was lower in the LISA compared with the pre-LISA epoch (adjusted odds ratio 0.62, 95% CI 0.48-0.79). CONCLUSIONS: The implementation of LISA in preterm infants was feasible but not associated with a reduction in the combined outcome death or BPD, although the results do suggest that LISA improved survival. Additional studies need to assess the long-term effects of LISA.

PURPOSE: To determine the frequency and clinico-epidemiological profile of patients with scrub typhus and to assess the performance characteristics of an ICT based rapid assay for its diagnosis. METHODS: This was an observational cross-sectional study conducted on 175 adults ≥18 years of age presenting with acute onset of fever (temperature >38 °C) for <14 days with any of the following features: eschar, rash, lymphadenopathy, hepatosplenomegaly, jaundice and multi-organ involvement. Immunocompromised patients, such as those with HIV/AIDS, malignancy, patients on cytotoxic drugs and on systemic corticosteroid therapy were excluded from the study. Cases were recruited from medicine wards of Lok Nayak Hospital. Serum from the cases was tested for Orientia tsutsugamushi specific IgM antibody by ELISA and rapid assay. The performance characteristics of rapid assay was evaluated by comparing it with ELISA as the reference standard. RESULTS: Out of 175 cases, 36 (20.6 %) were reactive for scrub typhus IgM ELISA, while 139 (79.4 %) were non-reactive. Maximum number of scrub typhus cases were in the age group of 21-30 years (41.7 %) with both genders affected equally. Majority of the scrub typhus cases resided in urban areas (69.4 %), belonged to lower middle class (38.9 %) and were seen between the monsoon months of July and October (75 %). Eschar, lymphadenopathy, jaundice, ascites, ARDS, myocarditis, DIC, raised LDH, raised ALP, hyperbilirubinemia, hyperphosphatemia, hypoalbuminemia and leucocytosis were found to be significantly associated with scrub typhus. The sensitivity and specificity of the scrub typhus IgM rapid assay when compared to IgM ELISA was 22.2 % and 100.0 %, respectively, with low kappa value of 0.312. CONCLUSION: The frequency of scrub typhus in AFI was found to be 20.6 %. In view of the poor sensitivity, the RDT used in our study cannot be recommended as the screening assay for serodiagnosis of scrub typhus.