Epidemiology and Outcomes of Critically Ill Children at Risk for Pediatric Acute Respiratory Distress Syndrome: A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study*

Abstract

Interventional trials aimed at pediatric acute respiratory distress syndrome prevention require accurate identification of high-risk patients. In this study, we aimed to characterize the frequency and outcomes of children meeting "at risk for pediatric acute respiratory distress syndrome" criteria as defined by the Pediatric Acute Lung Injury Consensus Conference.

Nutritional Support in Children Meeting the At-Risk for Pediatric Acute Respiratory Distress Syndrome Criteria

“…Over one-fifth (21.4%) of children meeting ARF-PARDS criteria in our study developed PARDS during their PICU stay, a rate similar to the multicenter, international PARDS Incidence and Epidemiology (PARDIE) substudy ( 25 ). While our observed 4.7% mortality rate for ARF-PARDS children who then developed PARDS was much lower than the 21.2% mortality rate reported in the PARDIE substudy, this may reflect our single-center design and our exclusions of patients with PARDS at admission, surgical disease and cardiac disease ( 25 , 26 ). The morbidity and mortality associated with PARDS, a disease that currently has no specific treatment, makes identifying preventative and therapeutic measures of high importance.…”

Pediatric Acute Respiratory Distress Syndrome—Will We Be Able to Predict It and Eventually Prevent It?*

“…Similarly, in children with PARDS, MOD is often associated with both early and late deaths, and neurologic dysfunction is more prominent in early deaths-mostly acute neurologic dysfunction and ultimately brain death that leads to withdrawal of treatment (this representing the most common form of death); refractory hypoxemia (which accounts for only approximately 20% of all deaths), along with MOD, are more common in late deaths (6). Shein et al (10) reported an overall ICU mortality of 6.3% in children on nasal support and 9.1% in those on invasive or full-face NIV, with variations from 1.1% in children with ARF-PARDS on nasal support that did not develop PARDS to 10.5% in those on invasive or full-face NIV that developed PARDS and 25.5% in children on nasal support that developed PARDS.…”

“…Given the morbidity and mortality associated with PARDS, the study by Shein et al (10) brings an important contribution to a better understanding of its epidemiology and outcomes, with practical implications for the pediatric intensivist as well as other professionals that provide care to children at risk of developing PARDS, and it also provides interesting insights to future research in the field that could help us predict and eventually prevent PARDS. The author has disclosed that she does not have any potential conflicts of interest.…”

“…In this issue, Critical Care Medicine publishes an important multicenter international study conducted by Shein et al (10), which examined the incidence and outcomes of children at-risk for (ARF) PARDS (ARF-PARDS) as defined by PALICC. In a large subsample of the Paediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) study (11), predominantly from highincome countries, the authors have analyzed data from 310 children meeting the PALICC "ARF-PARDS" criteria, evaluating the rate and timing of subsequent PARDS diagnosis, risk factors associated with PARDS, and its outcomes.…”

“…Children that progressed to PARDS received more blood products, diuretics, and total parenteral nutrition than those that did not (10); these were likely a response to hematologic, cardiovascular, and/or renal dysfunctions, and one cannot assume a causative relationship with progression to PARDS.…”