Clinical Outcomes in Pediatric Acute Respiratory Distress Syndrome

Abstract

Pediatric acute respiratory distress syndrome (PARDS) has a distinct epidemiological and outcome profile, relative to adult ARDS. Nonpulmonary processes, including multisystem organ failure, immunocompromising comorbidities, and acute neurologic failure, substantially impact short-term mortality, rendering this a problematic endpoint for interventional studies, either alone or as part of a composite, such as ventilator-free days (VFDs). Indeed, VFD itself contains hidden biases, making its use as an endpoint similarly difficult. However, endpoints other than short-term mortality and VFD are profoundly understudied in PARDS. Given the neuropsychiatric and functional impairment in adult survivors of ARDS, characterization of these morbidities in children with PARDS is of paramount importance. This chapter summarizes the existing pediatric literature and, using adult ARDS as a framework, suggests alternative clinically relevant outcomes deserving of further investigation. The goal is to identify important outcomes, both short- and long-term, to inform future interventional trials in PARDS.