Critical Care and Shock

Pulmonary coagulopathy in pediatric acute lung injury/acute respiratory distress syndrome

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Background: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are major causes of morbidity and mortality in pediatric intensive care units (PICUs). Prior work has shown disorder of inflammation and coagulation in ALI/ARDS. Activated protein C (APC) is a potential critical endogenous regulator of coagulation and inflammation in ALI/ARDS.

Material and Methods: We prospectively studied children admitted with ALI/ARDS. We obtained clinical data, initial blood coagulation profiles including plasma protein C (PC) activity and free protein S antigen (PS Ag).

Results: 27 patients with ALI/ARDS were recruited in our study; their mean age was at 6.4±5.2 years. Fifteen were survivors (55%), 12 were non-survivors (45%). Initial plasma PC activity was 72.0±27.6% and plasma free PS Ag was 58.52±29.8%. Platelets, PT & PTT were significantly abnormal compared between survivors and non-survivors (p=0.01, 0.02, 0.01). There was a significantly negative correlation between plasma PC with initial systolic blood pressure (r=0.5, p=0.008) and PS Ag (r=0.41, p=0.02). There was also a trend of negative correlation between plasma PC with ventilator day (r2=0.0009, p=0.1) and length of stay in PICU (r2=0.1, p=0.09).

Conclusions: This study suggests that most of our pediatric ALI/ARDS had abnormal coagulogram. Coagulation dysfunction including initial plasma PC activity might be associated with the overall outcome.