Pediatric Acute Respiratory Distress Syndrome: Definition and Epidemiology

Abstract

In 1821, Laennec described in his “Treatise on Diseases of the Chest” probably the first published description of ARDS. It was not until 1967, in a landmark article published in Lancet, that the term acute respiratory distress syndrome (ARDS) was mentioned. Like other clinical syndromes, ARDS lacks a definitive gold standard for diagnosis. In 1994, the American European Consensus Conference (AECC) defined ARDS as a syndrome of inflammation and increased permeability in the lungs that is associated with a constellation of clinical, radiologic, and physiologic abnormalities that cannot be explained by, but may coexist with, left atrial or pulmonary capillary hypertension. While this definition was used for nearly 30 years, there were several limitations of the AECC definition of ARDS related to the influence of ventilator settings on hypoxemia, timing of disease, noninvasive ventilation, defining a spectrum of hypoxemia severity in ARDS, and how to specifically handle left ventricular dysfunction. These limitations were addressed by the Berlin definition in 2012. While some of these issues are common between adults and children with ARDS, pediatric-specific considerations were not included in either Berlin or AECC definitions. In 2015, the Pediatric Acute Lung Injury Consensus Conference (PALICC) published specific definitions for pediatric ARDS (PARDS) and those gauged to be at risk for PARDS, as well as recommendations regarding management and suggested priorities for future research.