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.