The mortality rate of acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) is high in pediatric patients. Panico et al identified risk factors for mortality in these patients which can help to identify a patient who may benefit from more aggressive management. The authors are from Sao Paulo University, Federal University of Sao Paulo and Hospital Pequeno Principe in Brazil.

Patient selection: pediatric patient <= 15 years with ALI or ARDS (excluding chronic respiratory disease, chronic cardiac disease, congestive heart failure)


Outcome: mortality


Independent risk factors for mortality:

(1) number of organ failures on admission to the ICU (odds ratio 2.1)

(2) peak inspiratory pressure in cm H2O on day 1 (odds ratio 1.13)



The risk associated with peak inspiratory pressure may be the increase above normal rather than the absolute value.


Other findings associated with increased mortality:

(1) airway pressure gradient in cm H2O (equals the peak inspiratory pressure minus PEEP in cm H20)

(2) mean airway pressure over the first 7 days of mechanical ventilation

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