Prognostic relevance and inter-observer reliability of chest-imaging in pediatric ARDS: a pediatric acute respiratory distress incidence and epidemiology (PARDIE) study

López-Fernández, Yolanda M; Smith, Lincoln; Kohne, Joseph G.; Weinman, Jason P.; Modesto-Alapont, Vicent; Reyes-Domínguez, S.B.; Medina, Alberto; Piñeres-Olave, Byron Enrique; Mahieu, Natalie; Klein, Margaret J.; Flori, Heidi R.; Jouvet, Philippe; Khemani, Robinder G.

doi:10.1007/s00134-020-06074-7

Cited by 19 publications

(16 citation statements)

References 29 publications

(44 reference statements)

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“…[ 11 ]. PARDIE study details are published separately [ 10 – 14 ]. The Children’s Hospital Los Angeles (CHLA) Institutional Review Board (IRB) (CHLA 16-0043) originally approved the PARDIE protocol.…”

Section: Methodsmentioning

confidence: 99%

Mechanical power in pediatric acute respiratory distress syndrome: a PARDIE study

et al. 2022

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Background Mechanical power is a composite variable for energy transmitted to the respiratory system over time that may better capture risk for ventilator-induced lung injury than individual ventilator management components. We sought to evaluate if mechanical ventilation management with a high mechanical power is associated with fewer ventilator-free days (VFD) in children with pediatric acute respiratory distress syndrome (PARDS). Methods Retrospective analysis of a prospective observational international cohort study. Results There were 306 children from 55 pediatric intensive care units included. High mechanical power was associated with younger age, higher oxygenation index, a comorbid condition of bronchopulmonary dysplasia, higher tidal volume, higher delta pressure (peak inspiratory pressure—positive end-expiratory pressure), and higher respiratory rate. Higher mechanical power was associated with fewer 28-day VFD after controlling for confounding variables (per 0.1 J·min−1·Kg−1 Subdistribution Hazard Ratio (SHR) 0.93 (0.87, 0.98), p = 0.013). Higher mechanical power was not associated with higher intensive care unit mortality in multivariable analysis in the entire cohort (per 0.1 J·min−1·Kg−1 OR 1.12 [0.94, 1.32], p = 0.20). But was associated with higher mortality when excluding children who died due to neurologic reasons (per 0.1 J·min−1·Kg−1 OR 1.22 [1.01, 1.46], p = 0.036). In subgroup analyses by age, the association between higher mechanical power and fewer 28-day VFD remained only in children < 2-years-old (per 0.1 J·min−1·Kg−1 SHR 0.89 (0.82, 0.96), p = 0.005). Younger children were managed with lower tidal volume, higher delta pressure, higher respiratory rate, lower positive end-expiratory pressure, and higher PCO2 than older children. No individual ventilator management component mediated the effect of mechanical power on 28-day VFD. Conclusions Higher mechanical power is associated with fewer 28-day VFDs in children with PARDS. This association is strongest in children < 2-years-old in whom there are notable differences in mechanical ventilation management. While further validation is needed, these data highlight that ventilator management is associated with outcome in children with PARDS, and there may be subgroups of children with higher potential benefit from strategies to improve lung-protective ventilation. Take Home Message: Higher mechanical power is associated with fewer 28-day ventilator-free days in children with pediatric acute respiratory distress syndrome. This association is strongest in children <2-years-old in whom there are notable differences in mechanical ventilation management.

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Section: Methodsmentioning

confidence: 99%

Mechanical power in pediatric acute respiratory distress syndrome: a PARDIE study

et al. 2022

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“…The intervention of interest for this cohort study was administration of corticosteroids for SARS-CoV-2-related ARDS, regardless ness: (i) respiratory distress, respiratory rate ≥ 30 per minute; (ii) oxygen saturation at room air at rest ≤ 93%; or (iii) oxygen index less than 300 mmHg. We used the standard Berlin definition for ARDS (25)(26), with noninvasive SpO 2 /FiO 2 as a surrogate of PaO2/FiO 2 , which was allowed for patients without PaO 2 (27)(28)(29). An immunosuppressive status was defined as patients who had an underlying disease, such as human malignancy, liver cirrhosis, or chronic renal failure, diabetes, or receiving immunosuppressive therapy.…”

Section: Interventionmentioning

confidence: 99%

Corticosteroid treatment in severe COVID-19 patients with acute respiratory distress syndrome

Liu¹,

Zhang²,

Dong³

et al. 2020

Journal of Clinical Investigation

113

120

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“…De Luca and colleagues provided support for the usefulness of the Berlin definition in infants, but we could not confirm this in the present study [ 26 ]. However, we did find that the presence of bilateral consolidations on chest radiograph significantly added to mortality in contrast with the PARDIE study, making that there was higher mortality rate in severe patients when the Berlin definition was applied [ 27 ]. This warrants further study.…”

Section: Discussionmentioning

confidence: 92%

“…Third, the presence of LV dysfunction was not evaluated in all patients and only deemed present if noted in the electronic health record. Lastly, evaluating chest radiographs is very subjective and has a proven high inter-observer variability [ 27 , 30 – 32 ]. Our strategy was modelled after clinical practice where one observer interprets the chest-radiograph and only in case of uncertainty by a second observer.…”

Section: Discussionmentioning

confidence: 99%

Performance of acute respiratory distress syndrome definitions in a high acuity paediatric intensive care unit

et al. 2021

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Background For years, paediatric critical care practitioners used the adult American European Consensus Conference (AECC) and revised Berlin Definition (BD) for acute respiratory distress syndrome (ARDS) to study the epidemiology of paediatric ARDS (PARDS). In 2015, the paediatric specific definition, Paediatric Acute Lung Injury Consensus Conference (PALICC) was developed. The use of non-invasive metrics of oxygenation to stratify disease severity were introduced in this definition, although this potentially may lead to a confounding effect of disease severity since it is more common to place indwelling arterial lines in sicker patients. We tested the hypothesis that PALICC outperforms AECC/BD in our high acuity PICU, which employs a liberal use of indwelling arterial lines and high-frequency oscillatory ventilation (HFOV). Methods We retrospectively collected data from children < 18 years mechanically ventilated for at least 24 h in our tertiary care, university-affiliated paediatric intensive care unit. The primary endpoint was the difference in the number of PARDS cases between AECC/BD and PALICC. Secondary endpoints included mortality and ventilator free days. Performance was assessed by the area under the receiver operating characteristics curve (AUC-ROC). Results Data from 909 out of 2433 patients was eligible for analysis. AECC/BD identified 35 (1.4%) patients (mortality 25.7%), whereas PALICC identified 135 (5.5%) patients (mortality 14.1%). All but two patients meeting AECC/Berlin criteria were also identified by PALICC. Almost half of the cohort (45.2%) had mild, 33.3% moderate and 21.5% severe PALICC PARDS at onset. Highest mortality rates were seen in patients with AECC acute lung injury (ALI)/mild Berlin and severe PALICC PARDS. The AUC-ROC for Berlin was the highest 24 h (0.392 [0.124–0.659]) after onset. PALICC showed the highest AUC-ROC at the same moment however higher than Berlin (0.531 [0.345–0.716]). Mortality rates were significantly increased in patients with bilateral consolidations (9.3% unilateral vs 26.3% bilateral, p = 0.025). Conclusions PALICC identified more new cases PARDS than the AECC/Berlin definition. However, both PALICC and Berlin performed poorly in terms of mortality risk stratification. The presence of bilateral consolidations was associated with a higher mortality rate. Our findings may be considered in future modifications of the PALICC criteria.

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Prognostic relevance and inter-observer reliability of chest-imaging in pediatric ARDS: a pediatric acute respiratory distress incidence and epidemiology (PARDIE) study

Cited by 19 publications

References 29 publications

Mechanical power in pediatric acute respiratory distress syndrome: a PARDIE study

Mechanical power in pediatric acute respiratory distress syndrome: a PARDIE study

Corticosteroid treatment in severe COVID-19 patients with acute respiratory distress syndrome

Performance of acute respiratory distress syndrome definitions in a high acuity paediatric intensive care unit

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