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Background <p>Hypoxemia, a mortality predictor and hallmark of pediatric acute respiratory distress syndrome (PARDS), is disproportionately common in resource-constrained settings (RCS). The burden of PARDS in RCS is likely substantial considering the high prevalence of known clinical triggers (e.g., sepsis, pneumonia, trauma), but it is challenging to diagnose due to limited diagnostic resources. We aimed to: (1) describe respiratory care resource availability in RCS hospitals and test whether availability was associated with mortality; (2) determine the proportion of children who presented to RCS hospitals with hypoxemia and their associated outcomes; and (3) test whether, in children with hypoxemia, having a PARDS trigger was associated with mortality.</p> Methods <p>We developed and applied operational definitions for five tiered respiratory care resource bundles. Through a secondary analysis of Global Paediatric Acute Critical Illness Point Prevalence Study (PARITY) data, we performed descriptive statistics, hypothesis testing (i.e., chi-square and Wilcoxon rank-sum tests), and logistic regression analyses.</p> Results <p>Among the entire Global PARITY cohort (<i>n</i> = 7538), 763 (10.1%) were admitted with hypoxemia. Seventy percent (<i>n</i> = 531) were treated at a site with the intermediate or less respiratory care resource bundle available. Mortality was 6.8% (<i>n</i> = 52) and inversely associated with respiratory resource availability. The odds of mortality were higher for patients treated at sites with the intermediate bundle or less compared to those with the advanced or expert bundle available (adjusted odds ratio [OR] 18, 95% confidence interval [CI] 4.1–83). Fifty-six percent (<i>n</i> = 430) had a PARDS trigger, most commonly pneumonia (<i>n</i> = 256), bronchiolitis (<i>n</i> = 116), and sepsis (<i>n</i> = 58). There was no association between the presence of a PARDS trigger and mortality. Ninety-four percent of patients with a PARDS trigger (<i>n</i> = 405/430) had insufficient data available for a PARDS-related diagnosis according to the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines.</p> Conclusions <p>Children with hypoxemia treated at hospitals with respiratory care resource constraints in countries with lower socio-demographic index (SDI) had significantly higher mortality. These findings highlight the importance of ongoing work to improve resource availability, strengthen health systems, and support pediatric healthcare providers in identifying PARDS in order to help clinicians risk stratify children, focus resources, and tailor management to optimize outcomes.</p>

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Risk factors for mortality in children with hypoxemia in resource-constrained settings: a secondary analysis of Global Paediatric Acute Critical Illness Point Prevalence Study (PARITY)

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  • 发表日期：

    2026年1月9日

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  • Carter Biewen,
  • Shän L. Ward,
  • Asya Agulnik,
  • Srinivas Murthy,
  • Qalab Abbas,
  • Adnan Bhutta,
  • Jazmin Baez Maidana,
  • Adrian Holloway,
  • Jan Hau Lee,
  • Eliana López-Barón,
  • Christian Umuhoza,
  • Matthew O. Wiens,
  • Robinder G. Khemani,
  • Teresa B. Kortz,
  • Alhassan Abdul-Mumin,
  • Nabisere Allen,
  • Paloma Amarillo,
  • Kokou Amegan-Aho,
  • John Appiah,
  • Pamela Arancibia,
  • Anita Arias,
  • Fehmina Arif,
  • Liliana Arteaga,
  • Jacqueline Asibey,
  • Jonah Attebery,
  • Nataly Ávila Guerrero,
  • Tigist Bacha,
  • Briam Beltran Hernandez,
  • Hippolyte Bwiza Muhire,
  • Juan Calderon-Cardenas,
  • Jhon Camacho-Cruz,
  • Mariana Lucía Cañete,
  • Paula Caporal,
  • Dulamragchaa Chimedbazar,
  • Claudia Curi,
  • Karla Emilia de Sa Rodrigues,
  • Tenywa Emmanuel,
  • Maria Escobar,
  • Sofia Esposto,
  • Arieth Figueroa Vargas,
  • Ericka Fink,
  • Ana Fustiñana,
  • Marina Giulietti,
  • Stephanie Gordon Rivera,
  • Muhammad Irfan Habib,
  • Pascal Havugarurema,
  • David He,
  • Lucia Hernandez Somerson,
  • Nayibe Hincapie Saldarriaga,
  • Shubhada Hooli,
  • Jacob Isabirye,
  • Saifullah Jamro,
  • Juan Jaramillo-Bustamante,
  • Liliana Jurado Salcedo,
  • Halima Kabir,
  • Caleb Karanja,
  • Adama Mamby Keita,
  • Marie-Charlyne Kilba,
  • Niranjan Kissoon,
  • Guillermo Kohn-Loncarica,
  • Kandamaran Krishnamurthy,
  • Jorhk Lasso Noguera,
  • Marianne Majdalani,
  • Isabel Monje Cardona,
  • Emilse Montero Nuñez,
  • Celia Mulgado Aguas,
  • Raya Mussa,
  • Fiona Muttalib,
  • John Nebaza,
  • Katie Nielsen,
  • María Noya,
  • Edna Obodai,
  • Carmen Ocampo,
  • Çağlar Ödek,
  • Tagbo Oguonu,
  • Afua Osew-Gyamfi,
  • Sheila Owusu,
  • Larko Owusu,
  • Mayerly Palencia Bocarejo,
  • Freddy Pantoja Chamorro,
  • Aurora Pedroza,
  • Walugembe Peter,
  • Javier Prego,
  • Amal Rahi,
  • Carmen Ramírez Hernández,
  • Kenneth Remy,
  • Pedro Rino,
  • Adriana Teixeira Rodrigues,
  • Firas Sakaan,
  • Jhuma Sankar,
  • Hendry Sawe,
  • Jesus Serra,
  • Agustin Shaieb,
  • Arianna Shirk,
  • Enkhtur Shonkhuuz,
  • Javier Sierra-Abaunza,
  • Khurram Soomro,
  • Samba Sow,
  • Abner Tagoola,
  • Atnafu Tekleab,
  • Margarita Torres,
  • Pablo Vasquez-Hoyos,
  • Amelie von Saint Andre-von Arnim,
  • Justin Wang,
  • Rafiuk Yakubu,
  • Rita Yeboah,
  • María Zamarbideon

摘要

Background

Hypoxemia, a mortality predictor and hallmark of pediatric acute respiratory distress syndrome (PARDS), is disproportionately common in resource-constrained settings (RCS). The burden of PARDS in RCS is likely substantial considering the high prevalence of known clinical triggers (e.g., sepsis, pneumonia, trauma), but it is challenging to diagnose due to limited diagnostic resources. We aimed to: (1) describe respiratory care resource availability in RCS hospitals and test whether availability was associated with mortality; (2) determine the proportion of children who presented to RCS hospitals with hypoxemia and their associated outcomes; and (3) test whether, in children with hypoxemia, having a PARDS trigger was associated with mortality.

Methods

We developed and applied operational definitions for five tiered respiratory care resource bundles. Through a secondary analysis of Global Paediatric Acute Critical Illness Point Prevalence Study (PARITY) data, we performed descriptive statistics, hypothesis testing (i.e., chi-square and Wilcoxon rank-sum tests), and logistic regression analyses.

Results

Among the entire Global PARITY cohort (n = 7538), 763 (10.1%) were admitted with hypoxemia. Seventy percent (n = 531) were treated at a site with the intermediate or less respiratory care resource bundle available. Mortality was 6.8% (n = 52) and inversely associated with respiratory resource availability. The odds of mortality were higher for patients treated at sites with the intermediate bundle or less compared to those with the advanced or expert bundle available (adjusted odds ratio [OR] 18, 95% confidence interval [CI] 4.1–83). Fifty-six percent (n = 430) had a PARDS trigger, most commonly pneumonia (n = 256), bronchiolitis (n = 116), and sepsis (n = 58). There was no association between the presence of a PARDS trigger and mortality. Ninety-four percent of patients with a PARDS trigger (n = 405/430) had insufficient data available for a PARDS-related diagnosis according to the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines.

Conclusions

Children with hypoxemia treated at hospitals with respiratory care resource constraints in countries with lower socio-demographic index (SDI) had significantly higher mortality. These findings highlight the importance of ongoing work to improve resource availability, strengthen health systems, and support pediatric healthcare providers in identifying PARDS in order to help clinicians risk stratify children, focus resources, and tailor management to optimize outcomes.