Dead Space and Inhaled Nitric Oxide in Pediatric Acute Respiratory Distress Syndrome
Children's Hospital Los Angeles
Summary
The goal of this observational study is to determine whether a marker of dead space (the end-tidal to alveolar dead space fraction \[AVDSf\]) is more strongly associated with mortality risk than markers of oxygenation abnormality (oxygenation index) and to determine whether dead space (AVDSf) is an important marker of heterogeneity in the inhaled nitric oxide (iNO) treatment effect for children with acute respiratory distress syndrome (ARDS). The study aims are: 1. To validate AVDSf for risk stratification of mortality in pediatric ARDS 2. To determine if there is heterogeneity in treatment effect for iNO defined by AVDSf 3. To detect the association between AVDSf and microvascular dysfunction trajectory and whether iNO therapy modifies this association This is a prospective, multicenter observational study of 1260 mechanically ventilated children with moderate to severe ARDS. In a subgroup of 450 children with severe ARDS, longitudinal blood samples will be obtained to measure plasma protein markers.
Eligibility
- Age range
- 0–21 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Age \>37 weeks corrected gestational age to 21 years, including adults lacking the capacity to consent. * Within 72 hours of the start of invasive mechanical ventilation and meet the criteria for pediatric ARDS (new infiltrate on chest imaging and a known ARDS risk factor within 7 days of the onset of hypoxemia) and either meet criteria for moderate or severe pediatric ARDS between 4-72 hours of IMV (OI ≥ 8 or OSI ≥ 7.5) OR have an OI ≥ 20 or an OSI ≥ 14 x 15 minutes between 0-4 hours of IMV. * Subgroup of children eligible for longituduinal Blood Collection: Children wi…
Locations (10)
- Children's Hospital Los AngelesLos Angeles, California
- Children's Hospital ColoradoDenver, Colorado
- Boston Children's HospitalBoston, Massachusetts
- University of Michigan / CS Mott Children's HospitalAnn Arbor, Michigan
- University of Nebraska Medical Center / Children's Hospital and Medical CenterOmaha, Nebraska
- Cincinnati Children's Hospital Medical CenterCincinnati, Ohio