Lung Mechanics in Pediatric Acute Respiratory Distress Syndrome Associated to Acute COVID-19 and MIS-C: Implications for Therapies and Outcomes

Purpose: to describe lung mechanics in Pediatric Acute Respiratory Disease Syndrome (PARDS) associated with acute COVID-19 and MIS-C with respiratory failure.Methods: A concurrent multicenter observational study was performed, analyzing clinical variables and pulmonary mechanics of PARDS associated with COVID-19 in 4 Pediatric intensive care units (PICU) of Peru. Subgroup analysis included PARDS associated with multisystem inflammatory syndrome in children (MIS-C), MIS-PARDS, and PARDS with COVID-19 primary respiratory infection, C-PARDS. In addition, receiver operator curve analysis (ROC) for mortality and lung mechanics was performed.Results: 30 patients were included. Age was 7.5(4-11) years, 60% male, and mortality 23%. 47% corresponded to MIS-PARDS and 53% to C-PARDS groups. C-PARDS had positive RT-PCR in 67% and MIS-PARDS none (p<0.001). C-PARDS group had more profound hypoxemia (P/F ratio <100, 86% vs. 38%, p<0.01) and higher driving-pressure [14(10-22) vs10(10-12) cmH2O], and lower compliance of the respiratory system (C RS )[0.5(0.3-0.6)vs 0.7(0.6-0.8)ml/kg/cmH2O] compared to MIS-PARDS (all p<0.05). ROC-analysis for mortality showed that driving pressure had the best performance [AUC 0.91(95%CI0.81-1.00), with the best cut-point of 15 cmH2O (100% sensitivity and 87% of specificity). Mortality in C-PARDS was 38% and 7% in MIS-PARDS(p=0.09). MV free-days were 12(0-23) in C-PARDS and 23(21-25) in MIS-PARDS (p=0.02).Conclusion: Patients with C-PARDS, have lung mechanics characteristics similar to classic moderate to severe PARDS. This was not observed in patients with MIS-C. As seen in other studies, a driving pressure ≥ 15 cmH2O was the best discriminator for mortality. These findings can help guide ventilator management strategies for these two different presentations.Funding Information: No funding was involved in this research.Declaration of Interests: The authors declare no conflicts of interest.Ethics Approval Statement: Local IRB of each participating center approved the study (Approval letters 088-2021-CIEI-HNHU Hospital Nacional Hipolito Unanue, 011-2021-CIEI-HEVES Hospital de Emergencias de Villa El Salvador, 001-2021- COVID-HR Hospital Regional de Cusco, 42-IETSI-ESSALUD-2020 Hospital Edgardo Rebagliati Martins). Informed consent was waived due to gathering anonymized data previously collected for administrative and benchmarking purposes.