TY - JOUR
T1 - Critical pertussis illness in children
T2 - A multicenter prospective cohort study
AU - Berger, John T.
AU - Carcillo, Joseph A.
AU - Shanley, Thomas P.
AU - Wessel, David L.
AU - Clark, Amy
AU - Holubkov, Richard
AU - Meert, Kathleen L.
AU - Newth, Christopher J.L.
AU - Berg, Robert A.
AU - Heidemann, Sabrina
AU - Harrison, Rick
AU - Pollack, Murray
AU - Dalton, Heidi
AU - Harvill, Eric
AU - Karanikas, Alexia
AU - Liu, Teresa
AU - Burr, Jeri S.
AU - Doctor, Allan
AU - Dean, J. Michael
AU - Jenkins, Tammara L.
AU - Nicholson, Carol E.
PY - 2013/5
Y1 - 2013/5
N2 - Objective: Pertussis persists in the United States despite high immunization rates. This report characterizes the presentation and acute course of critical pertussis by quantifying demographic data, laboratory findings, clinical complications, and critical care therapies among children requiring admission to the PICU. Design: Prospective cohort study. Setting: Eight PICUs comprising the Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network and 17 additional PICUs across the United States. Patients: Eligible patients had laboratory confirmation of pertussis infection, were younger than 18 years old, and died in the PICU or were admitted to the PICU for at least 24 hours between June 2008 and August 2011. Interventions: None. Measurements and main results: A total of 127 patients were identified. Median age was 49 days, and 105 (83%) patients were less than 3 months old. Fifty-five (43%) patients required mechanical ventilation and 12 patients (9.4%) died during initial hospitalization. Pulmonary hypertension was found in 16 patients (12.5%) and was present in 75% of patients who died, compared with 6% of survivors (p < 0.001). Median WBC was significantly higher in those requiring mechanical ventilation (p < 0.001), those with pulmonary hypertension (p < 0.001), and nonsurvivors (p < 0.001). Age, sex, and immunization status did not differ between survivors and nonsurvivors. Fourteen patients received leukoreduction therapy (exchange transfusion [12], leukopheresis [1], or both [1]). Survival benefit was not apparent. Conclusions: Pulmonary hypertension may be associated with mortality in pertussis critical illness. Elevated WBC is associated with the need for mechanical ventilation, pulmonary hypertension, and mortality risk. Research is indicated to elucidate how pulmonary hypertension, immune responsiveness, and elevated WBC contribute to morbidity and mortality and whether leukoreduction might be efficacious.
AB - Objective: Pertussis persists in the United States despite high immunization rates. This report characterizes the presentation and acute course of critical pertussis by quantifying demographic data, laboratory findings, clinical complications, and critical care therapies among children requiring admission to the PICU. Design: Prospective cohort study. Setting: Eight PICUs comprising the Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network and 17 additional PICUs across the United States. Patients: Eligible patients had laboratory confirmation of pertussis infection, were younger than 18 years old, and died in the PICU or were admitted to the PICU for at least 24 hours between June 2008 and August 2011. Interventions: None. Measurements and main results: A total of 127 patients were identified. Median age was 49 days, and 105 (83%) patients were less than 3 months old. Fifty-five (43%) patients required mechanical ventilation and 12 patients (9.4%) died during initial hospitalization. Pulmonary hypertension was found in 16 patients (12.5%) and was present in 75% of patients who died, compared with 6% of survivors (p < 0.001). Median WBC was significantly higher in those requiring mechanical ventilation (p < 0.001), those with pulmonary hypertension (p < 0.001), and nonsurvivors (p < 0.001). Age, sex, and immunization status did not differ between survivors and nonsurvivors. Fourteen patients received leukoreduction therapy (exchange transfusion [12], leukopheresis [1], or both [1]). Survival benefit was not apparent. Conclusions: Pulmonary hypertension may be associated with mortality in pertussis critical illness. Elevated WBC is associated with the need for mechanical ventilation, pulmonary hypertension, and mortality risk. Research is indicated to elucidate how pulmonary hypertension, immune responsiveness, and elevated WBC contribute to morbidity and mortality and whether leukoreduction might be efficacious.
KW - Intensive care
KW - Leukocyte reduction procedures
KW - Outcome
KW - Pertussis
KW - Pulmonary hypertension
KW - Respiratory failure
UR - http://www.scopus.com/inward/record.url?scp=84877731671&partnerID=8YFLogxK
U2 - 10.1097/PCC.0b013e31828a70fe
DO - 10.1097/PCC.0b013e31828a70fe
M3 - Article
C2 - 23548960
AN - SCOPUS:84877731671
SN - 1529-7535
VL - 14
SP - 356
EP - 365
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 4
ER -