Outcomes of Children Surviving Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

Abstract

We conducted a scoping review to identify studies evaluating outcomes following PARDS. We included studies of survivors of PARDS, acute respiratory failure with a high proportion of PARDS patients, or other critical illnesses if PARDS-specific outcomes could be extracted.DATA EXTRACTION: Title/abstract review, full-text review, and data extraction using a standardized data collection form. DATA SYNTHESIS:The Grading of Recommendations Assessment, Development and Evaluation approach was used to identify and summarize evidence and develop recommendations. Of 8,037 abstracts screened, we identified 20 articles for inclusion. Morbidity following PARDS was common and affected multiple domains of pulmonary and nonpulmonary function. There was insufficient evidence to generate any evidence-based recommendations. We generated eight good practice statements and five research statements. A panel of 52 experts discussed each proposed good practice statement and research statement, and the agreement rate was measured with an online voting process. Good practice statements describe the approach to clinical outcome assessment, assessment of pulmonary outcomes of children surviving PARDS, and assessment of nonpulmonary outcomes of children surviving PARDS including health-related quality of life and physical, neurocognitive, emotional, family, and social functioning. The five research statements relate to assessment of patient preillness status, use of postdischarge endpoints for clinical trials, the association between short-term and longer term outcomes, the trajectory of recovery following PARDS, and practices to optimize follow-up. CONCLUSIONS:There is increasing evidence that children are at risk for impairments across a range of pulmonary and nonpulmonary health domains following hospitalization for PARDS. The results of this extensive scoping review and consensus conference involving experts in PARDS research, clinical care, and outcomes assessment provide guidance to clinicians and researchers on postdischarge follow-up to optimize the long-term health of patients surviving PARDS.

Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2)

“…There were another 112 statements: 18 related to the definition of PARDS and patients at risk for PARDS, 55 GPS, seven PS, and 32 RS. The evidence tables and rationale supporting CR are presented in the corresponding subgroup manuscripts (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24).…”

“…Section 9. Morbidity and Long-Term Outcomes (22) Approach to Clinical Outcome Assessment. Good practice statement 9.1.1.…”

“…Nevertheless, we believe these clinical practice guidelines will be valuable at the bedside, as we took into consideration feasibility, safety, equity, and implementation for all recommendations. Detailed considerations for all of these recommendations can be found in the supplemental articles (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). These guidelines have also identified many gaps that offer opportunities for the future PARDS research agenda.…”

“…We used a combination of medical subject heading terms and text words for concepts related to PARDS and each of the 11 sections. Search strategies are detailed in the methods article and supplemental digital files for each of the individual articles (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). References included in previous PALICC reviews were systematically added to the extracted evidence.…”

Methodology of the Second Pediatric Acute Lung Injury Consensus Conference

“…We developed Patient/Intervention/Comparator/ Outcome (PICO) questions specific to each topic, which are described in each of the articles in this supplement (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Although writing the manuscript, the authors reviewed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines for systematic reviews and scoping reviews, as applicable (18,19).…”