Introduction

Pediatric acute respiratory distress syndrome (PARDS) is a highly heterogeneous and complex clinical syndrome that exhibits certain clinical hallmarks, including hypoxemia accompanied by bilateral and diffuse pulmonary infiltrates. The prevalence of PARDS is relatively low, accounting for approximately 1%–10% of all pediatric intensive care unit (PICU) admissions, and its overall mortality rate has decreased from 40% to 18% over the past three decades [1, 2]. However, the increasing number of survivors has led to the realization that many experience long-term sequelae after PICU discharge, including respiratory and motor dysfunction. New morbidity in survivors refers to dysfunction caused by either the disease itself or the treatment modality, and such morbidity has been the subject of growing interest and concern in the field in recent years [3].
As the mortality rates of PARDS have improved, an increasing number of studies have focused on the associated morbidities and measurement of functional status among survivors. The Functional Status Scale (FSS) is a measurement tool used to quantify the degree of dysfunction in patients and their ability to perform normal daily activities required to meet basic needs [4]. The FSS score upon admission reflects baseline functional status before hospitalization, whereas the discharge score reflects the dysfunction level after treatment. Thus, given the simplicity of this scale, it has gradually become the most widely used grading system for evaluating the degree of dysfunction. For example, it has been used to accurately assess functional impairment in critically ill patients, including those with traumatic brain injury or septic shock, or in patients undergoing blood purification therapy [5-7]. However, only a few studies to date have used the FSS to evaluate functional status in patients with PARDS. The current morbidity rate among PARDS survivors is reportedly approximately 23% [8]. Additionally, patients with PARDS appear to exhibit poor overall functional status. The median FSS score upon admission to the PICU is 6, with a score of 11 after discharge, where FSS scores correlate with disease prognosis [9]. Moreover, children with acute respiratory distress syndrome (ARDS) are at risk of experiencing a decline in health-related quality of life and FSS scores that persist for up to 9 months post-discharge [10]. Therefore, identifying factors that influence mortality and functional status at discharge is crucial to ensuring optimal outcomes in this population.
This study had the following two aims: 1) to determine the mortality rate and analyze the associated risk factors of PARDS, with severe illness hypothesized to be associated with higher mortality rates; and 2) to determine the functional status of PARDS survivors upon admission and at discharge.