Evaluating the Performance of the Pediatric Acute Lung Injury Consensus Conference Definition of Acute Respiratory Distress Syndrome*

Parvathaneni, Kaushik; Belani, Sanjay; Leung, Denis H. Y.; Newth, Christopher J L; Khemani, Robinder G.

doi:10.1097/pcc.0000000000000945

Cited by 74 publications

(87 citation statements)

References 13 publications

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“…The introduction of OSI allows the application of a standardized definition to children without an arterial line [13]. According to a recent study, applying the PALICC definition more paediatric patients with ARDS may be identified and the mortality rate may be lowered except for the more severe group [14]. Epidemiological data and animal studies suggest there are age-dependent differences in distribution, causes and peculiarity of ARDS, whereas the pathophysiology of ARDS does not change.…”

Section: Berlin Definition Of Ards Validated For Adults: But What Abomentioning

confidence: 99%

Surfactants in Acute Respiratory Distress Syndrome in Infants and Children: Past, Present and Future

et al. 2017

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There is a lack of definitive data on the effective management of acute respiratory distress syndrome (ARDS) in infants and children. The development and validation of the Berlin definition (BD) for ARDS and the Pediatric Acute Lung Injury Consensus Conference (PALICC) recommendations in children represented a major advance in optimizing research and treatment, mainly due to the introduction of a severe ARDS category. Proposed reasons for the lack of consistent results with surfactants in children and infants compared with neonates include different causes, type of lung damage (direct or indirect), timing and mode of administration as well as the type of surfactant used. Secretory phospholipase A2 plays an important role in inflammation and possible dysfunction of surfactants in ARDS. Bronchoalveolar lavage (BAL) with normal saline and surfactant allows the removal of inhaled material, the recruitment of non-ventilating areas and the maintenance of the surfactant pool size. BAL with diluted surfactant allows rapid absorption of the surfactant at the air/liquid interface, which blocks the progression of pathological lung disease and in turn disrupts the inflammatory cycle. Importantly, it is now recognized that the type of surfactant, the time of administration and the method of administration could all play an important role in the management of ARDS, and there is evidence that surfactant is effective and well tolerated in children and infants with ARDS.

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Section: Berlin Definition Of Ards Validated For Adults: But What Abomentioning

confidence: 99%

Surfactants in Acute Respiratory Distress Syndrome in Infants and Children: Past, Present and Future

et al. 2017

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“…One major strength is that we prospectively screened and identified patients with PARDS using the PALICC definition . Strikingly, the adult definitions only identify a subset of children with PARDS per the PALICC criteria . Thus, our findings highlight the outcomes of the “new” cohort of PARDS survivors and provide an anchor for future studies in this field.…”

Section: Discussionmentioning

confidence: 77%

“…Compared to the adult Berlin 3 and American European Consensus Conference 12 definitions, the PALICC definition identifies nearly twice as many children with ARDS, including many with milder disease but also a subset of patients with severe ARDS that were not identified by adult definitions. 13,14 Overall mortality was lower when using the PALICC definition, 13 suggesting that the characteristics of the "new" cohort of PARDS survivors and their outcomes may differ from those of children identified through the adult definitions.…”

Section: Introductionmentioning

confidence: 99%

Post‐discharge respiratory outcomes of children with acute respiratory distress syndrome

Boucher

Mathy

Lacroix

et al. 2019

Pediatric Pulmonology

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Objectives While long‐term sequelae of acute respiratory distress syndrome (ARDS) are well‐documented in adults, few studies reported post‐discharge respiratory complications in pediatric ARDS (PARDS) and none used the recent Pediatric Acute Lung Injury Consensus Conference (PALICC) diagnostic criteria. This study describes the respiratory symptoms, pulmonary function, and health resource use of PARDS survivors at 3 months post‐discharge. Design Retrospective study. Patient Selection Children less than 18 years admitted to the intensive care unit of Sainte‐Justine University Health Center from 1st September 2015 to 1st July 2017, and meeting PALICC diagnostic criteria for PARDS. Methods We evaluated 38 of the 44 children with PARDS in the follow‐up clinic at a mean (SD) of 3.4 (2.0) months post‐discharge for respiratory symptoms, age‐appropriate pulmonary function tests (spirometry or oscillometry, maximal respiratory pressures), and all‐cause emergency department (ED) visits or rehospitalizations since discharge. Results Fourteen (36.8%) had abnormal respiratory symptoms (most commonly cough between respiratory infections and wheezing), 7 of whom (18.4%) presented new respiratory symptoms since PARDS diagnosis. A mild‐to‐moderate restrictive pattern was observed in 3 of 10 patients who performed spirometry and mildly decreased maximal inspiratory pressures were noted in 2 of 8 patients who performed these maneuvers. Nine (23.7%) patients consulted in the ED and 4 (10.5%) were rehospitalized post‐discharge. Conclusions Despite our cohort's limited sample size, our findings suggest that a significant proportion of PARDS survivors experience abnormal respiratory symptoms, pulmonary function deficits, and recurrent problems requiring medical attention. Larger, multicenter studies are required to identify risk factors associated with poor post‐discharge outcomes among PARDS survivors.

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“…We combined four previously published datasets of invasively mechanically ventilated children with PARDS (15)(16)(17)(18). Two of the datasets were gathered retrospectively by reviewing the electronic health records of pediatric ICU (PICU) patients admitted to Children's Hospital Los Angeles (CHLA) from 2000 to 2007 (15) and 2009 to 2013 (16). One dataset was gathered prospectively from patients admitted to the Children's Hospital of Philadelphia (CHOP) from 2011 to 2016 (17,18).…”

Section: Methodsmentioning

confidence: 99%

“…In general, there is reluctance to escalate PEEP above 10 cm H 2 O, particularly for younger children (8,11). Through secondary analysis of aggregated data from four previously published studies of children with pediatric ARDS (PARDS) (11,(15)(16)(17)(18), we sought to determine if patients managed with PEEP levels lower than recommended by the ARDSNet table for a given FI O 2 in actual practice had higher mortality than patients who were managed with PEEP levels consistent with or higher than recommended by the ARDSNet table.…”

mentioning

confidence: 99%

Positive End-Expiratory Pressure Lower Than the ARDS Network Protocol Is Associated with Higher Pediatric Acute Respiratory Distress Syndrome Mortality

Khemani

Parvathaneni

Yehya

et al. 2018

Am J Respir Crit Care Med

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108

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Evaluating the Performance of the Pediatric Acute Lung Injury Consensus Conference Definition of Acute Respiratory Distress Syndrome*

Cited by 74 publications

References 13 publications

Surfactants in Acute Respiratory Distress Syndrome in Infants and Children: Past, Present and Future

Surfactants in Acute Respiratory Distress Syndrome in Infants and Children: Past, Present and Future

Post‐discharge respiratory outcomes of children with acute respiratory distress syndrome

Positive End-Expiratory Pressure Lower Than the ARDS Network Protocol Is Associated with Higher Pediatric Acute Respiratory Distress Syndrome Mortality

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