(741) Is Pediatric Acute Respiratory Distress Syndrome After Submersion Injury Associated With Outcome?

Introduction: Submersion injury is the second leading cause of accidental death, and it is associated with death or severe disability in 40-70% of children. Information available in the field has been shown to have prognostic value. However, there is a paucity of data evaluating predictors of outcome after patients are admitted to the pediatric intensive care unit (PICU). Submersion injury can cause pediatric acute respiratory distress syndrome (ARDS) due to direct injury to the lungs. This study's objective was to examine the association of ARDS and clinical outcomes in mechanically ventilated children with submersion injury.

Methods: We conducted a single-center, observational, retrospective cohort study of patients admitted to a tertiary care PICU over a 6-year period (2017–2023). Children < 18 years of age who experienced a submersion injury, developed acute respiratory failure, and required mechanical ventilation were included (N=48). The exposure was ARDS based on the criteria: onset within seven days of clinical insult, oxygen saturation index (OSI) >= 5 or oxygenation index (OI) >= 4, pulmonary infiltrate present, and injury not explained by cardiac failure. The primary outcome was mortality. The secondary outcome was neurologic outcome assessed by pediatric cerebral performance category (PCPC) and pediatric overall performance category (POPC).

Results: The sample included 48 patients. Most patients were males (54%), and median age of patients was 3.4 (IQR 2.2–5.1). 77% of patients had no preexisting comorbidities. In the sample, 33 patients (69%) developed ARDS within 24 hours of admission. Of these patients, 4.2% had mild ARDS, 22.9% moderate, 43.8% severe. The mortality rate was 27.1% (13/48). Among patients who had ARDS, mortality was 27.2% (9/33); among patients without ARDS, mortality was 26.6% (4/15). The association of mortality and ARDS was not statistically significant (X2(1)= .002; p=1.00, Fisher’s exact test). Of the 35 survivors, PCPC/POPC at discharge was 71% normal, 20% mild disability, 6% severe, and 3% coma state. The association of PCPC/POPC and ARDS was not statistically significant (ps=.36).

Conclusions: The development of ARDS after submersion injury is not associated with mortality or neurologic outcome. Children with severe ARDS may still experience positive clinical outcomes.