Prevalence of acute lung injury and acute respiratory distress syndrome among children with severe respiratory distress in Kenyatta National Hospital

Abstract

Background: Acute lung injury (ALI) is defined as a syndrome of acute and persistent lung Inflammation with increased vascular permeability. Acute respiratory distress syndrome (ARDS) refers to a severe spectrum of ALI and shares the same criteria of definition with ALI but with Worse hypoxemia. There are no previous studies on ALI and ARDS carried out locally. Objectives: To determine the prevalence of ALI and ARDS amongst children hospitalized with respiratory distress at Kenyatta National Hospital (KNH and to describe the spectrum of clinical conditions associated with ALI and ARDS. Methods: A descriptive cross sectional study was conducted among children aged 2 months to 12 years hospitalized at KNH with respiratory distress (tachypnoea and use of accessory muscles of respiration). Results: We enrolled a total of 152 children with severe acute respiratory distress. Their median (IQR) age was nine (6 to 14) months. 77(50.7%) were males. Wasting, stunting and being Underweight was reported in 64 (42.1%), 15 (9.9%) and 49 (32.2%) children respectively. Fifty eight children had either ALI or ARDS thus an overall prevalence of 38.2% (95% Confidence Interval (CI) 16.2% - 45.9%). The prevalence of ARDS was 27.0% (95% CI 19.9%-34.0%). Seventeen children (11.2%) met the criteria for ALI. Analysis of the spectrum of clinical conditions associated with ALI/ARDS revealed that almost all the sampled children were suffering from pneumonia (150, 98.7%). Sixteen (10.2%) and three children (2.0%) were diagnosed with bronchiolitis and sepsis respectively. Gender, age, area of residence and having a family member who smokes were not associated with ALI or ARDS. Likewise, none of the anthropometric indices was associated with ALI or ARDS. More children who were reported to have been hospitalized in the past were found to have ALI or ARDS although this association failed to reach statistical significance (p=0.072). Conclusions and Recommendations: Prevalence of ARDS and ALI among children with severe respiratory distress was found to be 27.0% (95% CI: 19.9%- 34.0%) and 11.2% (95%CI 6.2%- 30.4%)respectively.