Risk factors in acute respiratory distress syndrome among children with cancer in Brazilian Amazon: An observational study





Respiratory Distress Syndrome; Epidemiology; Mechanical Ventilation; Neoplasias.


This study was undertaken to determine the incidence and potential risk factors associated with Acute Respiratory Distress Syndrome (ARDS) in pediatric oncologic patients undergoing invasive mechanical ventilation and the association between mortality risk factors and ARDS. Retrospective cohort study was conducted using data analysis of patients on admission to the PICU, that were submitted to invasive mechanical ventilation for over 24 hours. Shapiro-Wilk test and bivariate analysis within the group exposed to ARDS and the one not exposed, as well as Fisher's, Wilks G, chi-square tests, and Poisson logistic regression were applied, with significant variables p <0.05 and 95% CI. From que 181 pediatric cancer patients included in the study, 69.06% had ARDS, with 48% leukemia, 58.4% pneumonia, 60.8% febrile neutropenia, and 76.1% were in the maintenance chemotherapy phase; pH expressed higher relation with ARDS outcome and mortality. These data are important as this is one of the first studies carried out on ARDS in the pediatric cancer population in the North of Brazil, but further research is needed to better correlate risk factors and acute respiratory distress syndrome on such population.


ANVISA, Agência Nacional de Vigilância Sanitária. Caderno 2 -Critérios Diagnósticos de Infecções Relacionadas a Assistência à Saúde (2017). Brasília-DF, 2017. 2ª Edição. Disponível em: https://www20.anvisa.gov.br/segurancadopaciente/index.php/publicacoes/item/criteriosdiagnosticos-das-infeccoes-relacionadas-a-assistencia-a-saude

Azoulay, É., Mokart, D., Lambert, J., Lemiale, V., Rabbat, A., Kouatchet, A., ... & Schlemmer, B. (2010). Diagnostic strategy for hematology and oncology patients with acute respiratory failure: randomized controlled trial. American journal of respiratory and critical care medicine, 182(8), 1038-1046.

Baden, L. R., Swaminathan, S., Angarone, M., Blouin, G., Camins, B. C., Casper, C., ... & Smith, C. (2016). Prevention and treatment of cancer-related infections, version 2.2016, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network, 14(7), 882-913.

Beringer, N., Poole, J. E., Ballot, D. E., & Geel, J. A. (2017). Appropriateness of admissions of children with cancer to intensive care facilities in a resource-limited setting. SA Journal of Oncology, 1(1), 1-7.

Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica (2012). Saúde da criança: crescimento e desenvolvimento / Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. – Brasília: Ministério da Saúde, 2012. 272 p.: il. – (Cadernos de Atenção Básica, nº 33).

Elbahlawan, L., Srinivasan, A., & Morrison, R. R. (2016). A critical care and transplantation-based approach to acute respiratory failure after hematopoietic stem cell transplantation in children. Biology of Blood and Marrow Transplantation, 22(4), 617-626.

Elbahlawan, L. M., Morrison, R. R., Jeha, S., Cheng, C., Liu, W., & Fiser, R. T. (2011). Impact of neutrophil recovery on oxygenation in pediatric oncology patients with acute hypoxemic respiratory failure. Journal of pediatric hematology/oncology, 33(7), e296-e299.

Fuchs, H., Rossmann, N., Schmid, M. B., Hoenig, M., Thome, U., Mayer, B., ... & Hummler, H. D. (2017). Permissive hypercapnia for severe acute respiratory distress syndrome in immunocompromised children: A single center experience. PloS one, 12(6), e0179974.

Goldstein, B., Giroir, B., & Randolph, A. (2005). International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatric critical care medicine, 6(1), 2-8.

Khemani, R. G., Smith, L. S., Zimmerman, J. J., Erickson, S., & Pediatric Acute Lung Injury Consensus Conference Group. (2015). Pediatric acute respiratory distress syndrome: definition, incidence, and epidemiology: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatric Critical Care Medicine, 16(5_suppl), S23-S40.

Macêdo, T. M. F. D., Campos, T. F., Mendes, R. E. D. F., França, D. C., Chaves, G. S. D. S., & Mendonça, K. M. P. P. D. (2014). Pulmonary function of children with acute leukemia in maintenance phase of chemotherapy☆. Revista Paulista de Pediatria, 32, 320-325.

Nina G, N. M., & Sardinas C, S. (2018). Induction outcomes in children with acute lymphoblastic leukemia in the hospital del niño" Ovidio Aliaga Uria", period 2013-2015: case series. Cuadernos Hospital de Clínicas, 59, 17.

Rowan, C. M., Hege, K. M., Speicher, R. H., Goodman, M., Perkins, S. M., Slaven, J. E., ... & Nitu, M. E. (2012). Oxygenation index predicts mortality in pediatric stem cell transplant recipients requiring mechanical ventilation. Pediatric transplantation, 16(6), 645-650.

Pereira, A. S. et al. (2018). Metodologia da pesquisa cientifica. [free e-book]. Santa Maria UAB/NTE/UFSM. https://repositorio.ufsm.br/bitstream/handle/1/15824/Lic_Computacao_Metodologia-Pesquisa-Cientifica.pdf?sequence=1.

Pillon, M., Sperotto, F., Zattarin, E., Cattelan, M., Carraro, E., Contin, A. E., ... & Amigoni, A. (2019). Predictors of mortality after admission to pediatric intensive care unit in oncohematologic patients without history of hematopoietic stem cell transplantation: A single‐center experience. Pediatric blood & cancer, 66(10), e27892.17.

Pollack, M. M., Holubkov, R., Funai, T., Dean, J. M., Berger, J. T., Wessel, D. L., ... & Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. (2016). The pediatric risk of mortality score: update 2015. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 17(1), 2.

Rowan, C. M., Smith, L. S., Loomis, A., McArthur, J., Gertz, S. J., Fitzgerald, J. C., ... & Cheifetz, I. M. (2017). Pediatric acute respiratory distress syndrome in pediatric allogeneic hematopoietic stem cell transplants: a multicenter study. Pediatric critical care medicine, 18(4), 304-309.

Steliarova‐Foucher, E., Stiller, C., Lacour, B., & Kaatsch, P. (2005). International classification of childhood cancer. Cancer, 103(7), 1457-1467.

Schoenfeld, D. A., & Bernard, G. R. (2002). Statistical evaluation of ventilator-free days as an efficacy measure in clinical trials of treatments for acute respiratory distress syndrome. Critical care medicine, 30(8), 1772-1777.

Su, X., Bai, C., Hong, Q., Zhu, D., He, L., Wu, J., ... & Matthay, M. A. (2003). Effect of continuous hemofiltration on hemodynamics, lung inflammation and pulmonary edema in a canine model of acute lung injury. Intensive care medicine, 29(11), 2034-2042.

Tamburro, R. F., Barfield, R. C., Shaffer, M. L., Rajasekaran, S., Woodard, P., Morrison, R. R., ... & Sillos, E. M. (2008). Changes in outcomes (1996–2004) for pediatric oncology and hematopoietic stem cell transplant patients requiring invasive mechanical ventilation. Pediatric Critical Care Medicine, 9(3), 270-277.

Thomas, N. J., Spear, D., Wasserman, E., Pon, S., Markovitz, B., Singh, A. R., ... & Pediatric Acute Lung Injury and Sepsis Investigators Network. (2018). CALIPSO: a randomized controlled trial of calfactant for acute lung injury in pediatric stem cell and oncology patients. Biology of Blood and Marrow Transplantation, 24(12), 2479-2486.

WHO Multicentre Growth Reference Study Group (2019). WHO Child Growth Standards: Methods and Development. Length/height-forage, weightfor-age, weight-for-length, weight-for-height and body mass index-for age: methods and development. http://www.who.int/child growth/standards/technical_report/en/index.html. Acesso em 10 de setembro de 2019.

Zinter, M. S., Dvorak, C. C., Mayday, M. Y., Iwanaga, K., Ly, N. P., McGarry, M. E., ... & DeRisi, J. L. (2019). Pulmonary metagenomic sequencing suggests missed infections in immunocompromised children. Clinical Infectious Diseases, 68(11), 1847-1855.




How to Cite

FARIAS, E. C. F. de .; PAVÃO JÚNIOR, M. J. C. .; DIAS, L. G. .; SILVA, E. R. da; ROCHA, R. S. B. .; CUNHA, K. da C. .; CHERMONT, A. G. . Risk factors in acute respiratory distress syndrome among children with cancer in Brazilian Amazon: An observational study. Research, Society and Development, [S. l.], v. 10, n. 9, p. e41710917767, 2021. DOI: 10.33448/rsd-v10i9.17767. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/17767. Acesso em: 21 sep. 2021.



Health Sciences