TY - JOUR
T1 - Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE)
T2 - an international, observational study
AU - Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology (PARDIE) Investigators
AU - Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network
AU - Khemani, Robinder G.
AU - Smith, Lincoln
AU - Lopez-Fernandez, Yolanda M.
AU - Kwok, Jeni
AU - Morzov, Rica
AU - Klein, Margaret J.
AU - Yehya, Nadir
AU - Willson, Douglas
AU - Kneyber, Martin C.J.
AU - Lillie, Jon
AU - Fernandez, Analia
AU - Newth, Christopher J.L.
AU - Jouvet, Philippe
AU - Thomas, Neal J.
AU - Abaleke, Eugenia
AU - Ackerman, Kate G.
AU - Acuña, Carlos
AU - Adu-Darko, Michelle
AU - Affolter, Jeremy T.
AU - Agbeko, Rachel
AU - Al Amoudi, Ahmed
AU - Alahmadti, Ahmad
AU - Aldairi, Nedaa
AU - Alibrahim, Omar
AU - Allen, Kiona
AU - Allen, Christine
AU - Al-Subu, Awni
AU - Althabe, María
AU - Alvear, Jimena
AU - Anil, Ayse Berna
AU - Anthony, Heather
AU - Aramburo, Angela
AU - Arjona Villanueva, David
AU - Ashtari, Neda
AU - Ávila Vera, Antonio
AU - Baines, Paul
AU - Bales, Melissa
AU - Barr, Samantha
AU - Barry, Dana
AU - Baudin, Florent
AU - Beca, John
AU - Beltramo, Fernando
AU - Benken, Laura
AU - Bhalla, Anoopindar
AU - Blom, Andrea
AU - Botta, Priscila
AU - Bourgoin, Pierre
AU - Brezmes, Marta
AU - Lin, John C.
AU - Spinella, Philip
N1 - Publisher Copyright:
© 2019 Elsevier Ltd
PY - 2019/2
Y1 - 2019/2
N2 - Background: Paediatric acute respiratory distress syndrome (PARDS) is associated with high mortality in children, but until recently no paediatric-specific diagnostic criteria existed. The Pediatric Acute Lung Injury Consensus Conference (PALICC) definition was developed to overcome limitations of the Berlin definition, which was designed and validated for adults. We aimed to determine the incidence and outcomes of children who meet the PALICC definition of PARDS. Methods: In this international, prospective, cross-sectional, observational study, 145 paediatric intensive care units (PICUs) from 27 countries were recruited, and over a continuous 5 day period across 10 weeks all patients were screened for enrolment. Patients were included if they had a new diagnosis of PARDS that met PALICC criteria during the study week. Exclusion criteria included meeting PARDS criteria more than 24 h before screening, cyanotic heart disease, active perinatal lung disease, and preparation or recovery from a cardiac intervention. Data were collected on the PICU characteristics, patient demographics, and elements of PARDS (ie, PARDS risk factors, hypoxaemia severity metrics, type of ventilation), comorbidities, chest imaging, arterial blood gas measurements, and pulse oximetry. The primary outcome was PICU mortality. Secondary outcomes included 90 day mortality, duration of invasive mechanical and non-invasive ventilation, and cause of death. Findings: Between May 9, 2016, and June 16, 2017, during the 10 study weeks, 23 280 patients were admitted to participating PICUs, of whom 744 (3·2%) were identified as having PARDS. 95% (708 of 744) of patients had complete data for analysis, with 17% (121 of 708; 95% CI 14–20) mortality, whereas only 32% (230 of 708) of patients met Berlin criteria with 27% (61 of 230) mortality. Based on hypoxaemia severity at PARDS diagnosis, mortality was similar among those who were non-invasively ventilated and with mild or moderate PARDS (10–15%), but higher for those with severe PARDS (33% [54 of 165; 95% CI 26–41]). 50% (80 of 160) of non-invasively ventilated patients with PARDS were subsequently intubated, with 25% (20 of 80; 95% CI 16–36) mortality. By use of PALICC PARDS definition, severity of PARDS at 6 h after initial diagnosis (area under the curve [AUC] 0·69, 95% CI 0·62–0·76) discriminates PICU mortality better than severity at PARDS diagnosis (AUC 0·64, 0·58–0·71), and outperforms Berlin severity groups at 6 h (0·64, 0·58–0·70; p=0·01). Interpretation: The PALICC definition identified more children as having PARDS than the Berlin definition, and PALICC PARDS severity groupings improved the stratification of mortality risk, particularly when applied 6 h after PARDS diagnosis. The PALICC PARDS framework should be considered for use in future epidemiological and therapeutic research among children with PARDS. Funding: University of Southern California Clinical Translational Science Institute, Sainte Justine Children's Hospital, University of Montreal, Canada, Réseau en Santé Respiratoire du Fonds de Recherche Quebec-Santé and Children's Hospital Los Angeles, Department of Anesthesiology and Critical Care Medicine.
AB - Background: Paediatric acute respiratory distress syndrome (PARDS) is associated with high mortality in children, but until recently no paediatric-specific diagnostic criteria existed. The Pediatric Acute Lung Injury Consensus Conference (PALICC) definition was developed to overcome limitations of the Berlin definition, which was designed and validated for adults. We aimed to determine the incidence and outcomes of children who meet the PALICC definition of PARDS. Methods: In this international, prospective, cross-sectional, observational study, 145 paediatric intensive care units (PICUs) from 27 countries were recruited, and over a continuous 5 day period across 10 weeks all patients were screened for enrolment. Patients were included if they had a new diagnosis of PARDS that met PALICC criteria during the study week. Exclusion criteria included meeting PARDS criteria more than 24 h before screening, cyanotic heart disease, active perinatal lung disease, and preparation or recovery from a cardiac intervention. Data were collected on the PICU characteristics, patient demographics, and elements of PARDS (ie, PARDS risk factors, hypoxaemia severity metrics, type of ventilation), comorbidities, chest imaging, arterial blood gas measurements, and pulse oximetry. The primary outcome was PICU mortality. Secondary outcomes included 90 day mortality, duration of invasive mechanical and non-invasive ventilation, and cause of death. Findings: Between May 9, 2016, and June 16, 2017, during the 10 study weeks, 23 280 patients were admitted to participating PICUs, of whom 744 (3·2%) were identified as having PARDS. 95% (708 of 744) of patients had complete data for analysis, with 17% (121 of 708; 95% CI 14–20) mortality, whereas only 32% (230 of 708) of patients met Berlin criteria with 27% (61 of 230) mortality. Based on hypoxaemia severity at PARDS diagnosis, mortality was similar among those who were non-invasively ventilated and with mild or moderate PARDS (10–15%), but higher for those with severe PARDS (33% [54 of 165; 95% CI 26–41]). 50% (80 of 160) of non-invasively ventilated patients with PARDS were subsequently intubated, with 25% (20 of 80; 95% CI 16–36) mortality. By use of PALICC PARDS definition, severity of PARDS at 6 h after initial diagnosis (area under the curve [AUC] 0·69, 95% CI 0·62–0·76) discriminates PICU mortality better than severity at PARDS diagnosis (AUC 0·64, 0·58–0·71), and outperforms Berlin severity groups at 6 h (0·64, 0·58–0·70; p=0·01). Interpretation: The PALICC definition identified more children as having PARDS than the Berlin definition, and PALICC PARDS severity groupings improved the stratification of mortality risk, particularly when applied 6 h after PARDS diagnosis. The PALICC PARDS framework should be considered for use in future epidemiological and therapeutic research among children with PARDS. Funding: University of Southern California Clinical Translational Science Institute, Sainte Justine Children's Hospital, University of Montreal, Canada, Réseau en Santé Respiratoire du Fonds de Recherche Quebec-Santé and Children's Hospital Los Angeles, Department of Anesthesiology and Critical Care Medicine.
UR - http://www.scopus.com/inward/record.url?scp=85055089832&partnerID=8YFLogxK
U2 - 10.1016/S2213-2600(18)30344-8
DO - 10.1016/S2213-2600(18)30344-8
M3 - Article
C2 - 30361119
AN - SCOPUS:85055089832
SN - 2213-2600
VL - 7
SP - 115
EP - 128
JO - The Lancet Respiratory Medicine
JF - The Lancet Respiratory Medicine
IS - 2
ER -