Abstract
Our objective was to compare the prevalence and outcomes of pediatric acute respiratory distress syndrome using the Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria and Berlin definitions. We screened case records of all children aged 1 month to 17 years of age admitted to the Pediatric Intensive Care Unit (PICU) over a 3-year period (2015-2017) for presence of any respiratory difficulty at admission or during PICU stay. We applied both PALICC and Berlin criteria to these patients. Data collection included definition and outcome related variables. Data were compared between the "PALICC only group" and the "Berlin with or without PALICC" group using Stata 11. Of a total of 615 admissions, 246 were identified as having respiratory difficulty at admission or during PICU stay. A total of 61 children (prevalence 9.9%; 95% CI: 7.8-12.4) fulfilled the definition of acute respiratory distress syndrome (ARDS) with either of the two criteria. While 60 children (98%) fulfilled PALICC criteria, only 26 children (43%) fulfilled Berlin definition. There was moderate agreement between the two definitions (Kappa: 0.51; 95% CI: 0.40-0.62; observed agreement 85%). Greater proportion of patients had severe ARDS in the "Berlin with or without PALICC group" as compared to the "PALICC only" group (50 vs. 19%). There was no difference between the groups with regard to key clinical outcomes such as duration of ventilation (7 vs. 8 days) or mortality [51.4 vs. 57.7%: RR (95% CI): 0.99 (0.64-1.5)]. In comparison to Berlin definition, the PALICC criteria identified more number of patients with ARDS. Proportion with severe ARDS and complications was greater in the "Berlin with or without PALICC" group as compared to the "PALICC only" group. There were no differences in clinical outcomes between the groups.
Highlights
Ashbaugh et al first described acute respiratory distress syndrome (ARDS) as a syndrome of tachypnea, hypoxia, and decreased pulmonary compliance (1)
Both were applicable more to the adult population and despite the different epidemiology and outcomes of pediatric acute respiratory distress syndrome (PARDS), these were applied to children without modification (7)
Notable differences in the Pediatric Acute Lung Injury Consensus Conference (PALICC) definition are use of oxygenation index (OI) instead of PaO2/FiO2, option of using SpO2-based indices, and less restrictive radiographic criteria. It includes chronic lung disease (CLD) and cardiac conditions [congenital heart disease (CHD)] which contribute to a significant number of patients with ARDS which were previously excluded (8)
Summary
Ashbaugh et al first described acute respiratory distress syndrome (ARDS) as a syndrome of tachypnea, hypoxia, and decreased pulmonary compliance (1). Thereafter, in 2012, Berlin definition of ARDS was proposed with few modifications (6) Both were applicable more to the adult population and despite the different epidemiology and outcomes of pediatric acute respiratory distress syndrome (PARDS), these were applied to children without modification (7). To address this issue, the Pediatric Acute Lung Injury Consensus Conference (PALICC) was convened to propose specific definitions for PARDS in 2014. Notable differences in the PALICC definition are use of oxygenation index (OI) instead of PaO2/FiO2, option of using SpO2-based indices, and less restrictive radiographic criteria It includes chronic lung disease (CLD) and cardiac conditions [congenital heart disease (CHD)] which contribute to a significant number of patients with ARDS which were previously excluded (8)
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