ABSTRACT 481

Abstract

Background and aims: The most accepted definition for acute respiratory distress syndrome (ARDS) remains the American-European Consensus Conference (AECC) definition. Other proposed definitions include the Berlin definition, SpO2:FiO2 ratio (S/F ratio), oxygenation index (OI), and oxygenation saturation index (OSI). Aims: Our aim is to compare these definitions with regard to reclassification of children with ARDS. Methods: We identified patients with ARDS (based on AECC’s definition) between 2009 and 2012. The Institutional Review Board approved this study. The following cutoffs were used.Table: No title available.Results: 26 patients were identified. ARDS incidence was 6.3/1000 of PICU admissions. Median age was 8.3years (4 days-17 years). Median PRISM2 score was 6.4 (0.7–86.3). Overall mortality was 62%. 51 arterial blood gas and saturation readings were analyzed. The Berlin definition for moderate-severe ARDS did not change any classification. On day 1, the S/F ratio identified all cases of ALI and ARDS but the OI and OSI reclassified one and two patients from ARDS to ALI respectively. On day 2, S/F ratio, OI and OSI reclassified two patients with normal P/F ratios into either ALI or ARDS. These patients were on excessively high FiO2. Conclusions: AECC and Berlin definition identified the same patients. SpO2 based markers overestimate lung injury when excessively high FiO2 is used. Further studies on these definitions are needed.