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Clinical Pediatrics
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Outcome of Respiratory Failure: A Case-Control Study

Roberto Caballero

Division of Critical Care, Cook Children's Medical Center, Fort Worth, Texas

Reese H. Clark

Division of Neonatology, Emory University School of Medicine

Jean A. Wright

Division of Critical Care & Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA

Despite the availability of ECMO (extracorporeal membrane oxygenation) services for nearly a decade, the criteria for the institution of ECMO for pediatric respiratory failure are still not clearly defined. Therefore, a chart review was performed on children who were mechanically ventilated more than 48 hours in 1989-1990 in order to evaluate possible predictors of death from pediatric respiratory failure. Twenty-three children died as a consequence of respiratory failure. Nonsurvivors in both years were compared with the 78 survivors in 1990, and potential predictors were subjected to multivariate analysis. After 4 days of mechanical ventilation, an alveolar-arterial oxygen gradient (AaD02) greater than 400 torr (53.3 kPa) was a weak predictor of death due to respiratory failure, and yet an AaD02 less than 400 torr (53.3 kPa) was a stronger predictor of survivability. Combination of variables did not yield a better predictor than any single variable. Early prediction of mortality from respiratory failure in this population was not found.

Clinical Pediatrics, Vol. 35, No. 4, 199-204 (1996)
DOI: 10.1177/000992289603500404
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