2001 OPEN FORUM Abstracts
OUTCOMESOF PULMONARY HEMORRHAGE SYNDROMES (PHS) INTHE PEDIATRIC INTENSIVE CARE UNIT (PICU)
Colleen Upton,R.R.T., William Wheeler, M.D., and James Sidman, M.D. Divisions of Otolaryngology and CriticalCare Medicine, Children?s Hospitals and Clinics, Minneapolis, MN.
BACKGROUND AND OBJECTIVE:Pulmonary hemorrhage in the PICU is diagnosed more frequently than in past yearsand is caused by multiple etiologies. We sought to determine the outcomes inpatients with PHS presenting with respiratory failure, particularly when analyzedin terms of the type of bleeding on presentation.
METHODS: We retrospectivelyevaluated outcomes of all pediatric patients aged 10 days to 16 years admittedto our PICU with acute PHS and respiratory failure from January 1995 throughDecember 2000. We assessed each patient for type of hemorrhage [diffuse alveolar(DAH) versus localized airway/parenchymal (LAP)]. This was determined on admissionby radiography and bronchoscopy. Outcomes measured included days of mechanicalventilation (MV), need for high frequency oscillation (HFO), days of hospitalstay (HD), recurrence of bleeding (R), development of multi-organ failure (MOF),need for surgical intervention (S), need for home care (HC), and survival.
There were no significantdifferences between groups in mean airway pressure, need for inhaled nitricoxide, or length of PICU stay. There was a significant difference in the frequencyof recurrent pulmonary bleeding in the LAP group, many of whom had congenitalheart disease or pulmonary vascular lesions.
Conclusions:We conclude that DAH with respiratory failure have substantially better outcomesthan LAH presenting to PICU. We speculate that these differences may be relatedto underlying, poorly responsive lesions resulting in recurrent PHS. Multipleearly interventions may be necessary in this group of patients.