537 - Availability of Resources for the Management of Pediatric Acute Respiratory Distress Syndrome in Resource-Limited Settings: a secondary analysis of the Global PARITY Study

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 537
Publication Number: 537.409

Carter Biewen, UCSF Benioff Children's Hospital San Francisco, Oakland, CA, United States; Asya Agulnik, St. Jude Children's Research Hospital, Memphis, TN, United States; Shan L. Ward, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Srinivas Murthy, University of British Columbia, Vancouver, BC, Canada; Robinder Khemani, Childrens hospital los angeles university of southern california, Los Angeles, CA, United States; Teresa B. Kortz, University of California, San Francisco, School of Medicine, San Francisco, CA, United States

Presenting Author(s)

CB

Carter Biewen, MD (he/him/his)

Fellow
UCSF Benioff Children's Hospital San Francisco
Oakland, California, United States

Background:

Pediatric acute respiratory distress syndrome (PARDS) is associated with high mortality globally. Previous studies have shown a higher proportion of mortality in middle-income countries compared to high-income countries, suggesting that resource availability and PARDS expertise may impact outcomes. Few studies evaluate PARDS in resource-limited settings (RLS). We explore PARDS resource availability through a secondary analysis of a Global PARITY (Pediatric Acute cRitical Illness sTudY) study.

Objective:

To describe resources available for managing PARDS in resource-limited hospitals.

Design/Methods:

We performed a secondary analysis of Global PARITY data. Global PARITY is a multinational prospective point prevalence study of children presenting to an emergency department in RLS. We used responses to the P</span>ediatric Acute Care Infrastructure and Resource Availability Survey describing participating center structure and resources to assess availability of PARDS-related resources at Global PARITY sites. To determine essential PARDS-related resources and tiered bundles of resources, we drew from the expert consensus on Essential Emergency and Critical Care as well as the Resource and Infrastructure Survey. Tiered bundles include basic, (e.g. oxygen, suction), intermediate (e.g. laryngoscopes, non-invasive positive pressure), advanced (e.g. oscillator, inhaled nitric oxide) and expert (e.g. extracorporeal membrane oxygenation). Resources were considered consistently available if survey responses indicated they were “always” or “often” available. Sites met bundle criteria if at least 80% of bundled resources were consistently available. We summarized resource bundle availability overall and by region.

Results:

Providers at 48 Global PARITY sites in 18 countries responded to the survey. Regional breakdown of sites included: South America (39.6%), West Africa (22.9%), East Africa (16.7%), Middle East/India/Pakistan (14.6%), North and Central America (4.2%), Southeast Asia (2.1%). Overall 95.8%, 81.3%, 45.8% and 6.3% of sites had basic, intermediate, advanced and expert bundles consistently available respectively.

Conclusion(s):

The basic bundle of PARDS resources is consistently available at most participating hospitals in RLS. South America had the highest proportion of sites with advanced bundle resources available. Understanding resource availability is a critical first step in identifying strategies to improve PARDS outcomes. Paired with outcomes data, this analysis will inform future work exploring PARDS and the potential relationship between resource availability and outcomes.