Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study
| Authors |
KHEMANI RG SMITH L LOPEZ-FERNANDEZ YM KWOK J MORZOV R KLEIN MJ YEHYA N WILLSON D KNEYBER MCJ LILLIE J FERNANDEZ A NEWTH CJL JOUVET P NJ Thomas ALTHABE M AA Vera BOTTA P CAPOCASA P CASTELLANI P CINQUEGRANI K ESPANOL SF FERNANDEZ A FERREYRA M FORTINI YV GIAMPIERI M IOLSTER T LANDRY LM MONJES C MONTES MJ ORQUEDA D PAZIENCIA F PEDRAZA C POTERALA R ROSEMARY D SFORZA J SERRATE AS TORRES SF TURON G VIDAL NA BARR S BUTT W DELZOPPO C ERICKSON S PINTIMALLA A SHEA S RIVERA GAG LEON AFM DUMITRASCU M EMERIAUD G FRENCH ME JOUVET P ACUNA C ALVEAR J CARO D CASTILLO IAE CORTEZ A ROMERO PC DIAZ F MUNDACA LG MEDINA T NUNEZ MJ MADRID PP ARAYA AW CHEN Y IZQUIERDO LM ALARCON YPL VEGA LM CARRERO RP LOZANO GP OLAVE BEP LOPEZ DQ HOYOS PV ORREGO CZ VAVŘINA Martin ŽUREK Jiří CAMPOS-MINO S YEROVI R BAUDIN F BOURGOIN P BRIDIER A GENUINI M GUICHOUX J MARIA M MILESI C PAYEN V STARCK J TRAVERT B BRIASSOULIS G ILIA S CAMPORESI A CHIUSOLO F DI Nardo M KIDA Y KYO M OHSHIMO S SHIME N TABATA Y ELGHUWAEL I LUM LCS TAI CW TANG SF QUIJADA AEJ RIVERA NJJ DIJKSTRA S KNEYBER M BECA J REA M SHERRING C VARGAS GSI CORTEZ GR TANTALEAN J MIRANDA DV PAGOWSKA-KLIMEK I CAMILO C ESCOBAR CG MONIZ MS AL Amoudi A ALAHMADTI A ALDAIRI N HAZWANI T TAYLOR R VILLANUEVA DA BREZMES M SANAGUSTIN SB GABOLI M CASAS PG GONZALEZ MG ORAYEN CG GOMEZ JMG DE la Fuente AML FERNANDEZ YL LOPEZ-HERCE J REVILLA PM MARTINEZ L DE Azagra AM MEDINA A MENDIZABAL M ALAPONT VMI MARTINEZ AM VERGARA EO ARIAS DP PARRILLA J ORIVE JP ODENA MP DOMINGUEZ SR CAMPOY PR DIAZ JIS VALLE JR ANIL AB CAN FK DURSUN O ONGUN EA ABALEKE E AGBEKO R ARAMBURO A BAINES P BRIERLEY J DEEP A DOMINGUEZ TE DWARAKANATHAN B FEATHER C FEINSTEIN Y FORTUNE PM GALE H INWALD D JENNINGS C JONES D LAWTON-WOODHALL A LILLIE J MACRAE D MCCORKELL J MCINTYRE K MELLISH C MILDNER R ORUGANTI S PAPPACHAN J PLUNKETT A SADASIVAM K SHEWARD V SILVESTRE C SUBRAMANIAN G SUNDARARAJAN S SYKES K WALSH L WEITZ J ACKERMAN KG ADU-DARKO M AFFOLTER JT ALIBRAHIM O ALLEN K ALLEN C AL-SUBU A ANTHONY H ASHTARI N BALES M BARRY D BELTRAMO F BENKEN L BHALLA A BLOM A BRODEN E BYSANI K CARROLL C CHIMA RS COATES B CORONADO-MUNOZ A CULLIMORE M CVIJANOVICH N DAHMER MK DOCKERY WK ESTIL JB FLORI H GAUTAM R GEDEIT R GERTZ S GIULIANO JS GOVANTES B HAILESELASSIE B HAN YY HARRELL A HARTMANN S HEFLEY G HENDERSON G HSING DD HUGHES-SCHALK A HUME J JAFARI-NAMIN S JAIMON N JARVIS JD JAYACHANDRAN C JEYAPALAN AS KASCH M KEARY J KELLEY C KESSEL A KHEMANI R KING C KNIOLA A KRALLMAN K KUBIS S KUSTKA L KWOK J LATIFI S JC Lin MADDUX AB MAHAPATRA S MERRITT C MONJURE T MORGAN R MORZOV R MOURANI PM MURKOWSKI K MURPHY M NAPOLITANO N NERHEIM D NETT ST NEWTH C NOFZIGER R PARKER MM PATANKAR N PINTO N PON S QIAO H RALSTON K RATIU A RODGERS C RONAN L ROWAN C SANDERS R SANTANELLI J SAPRU A SCHNEIDER J SHEIN SL SHUKLA A SIERRA Y SIKORA L SINGLETON M SLONIEWSKY D SMITH R SMITH L SONG H SPAEDER M SPEAR D SPINELLA P STONEMAN E SU F SULLIVAN E SWEBERG T TALA J THOMAS N TIEVES KS TORERO L TOTAPALLY B TRUEMPER E TYPPO K VIRK M WELLISCH L WILLSON D WOODS K YEHYA N YUNGER T |
|---|---|
| Year of publication | 2019 |
| Type | Article in Periodical |
| Magazine / Source | LANCET RESPIRATORY MEDICINE |
| Citation | |
| Doi | http://dx.doi.org/10.1016/S2213-2600(18)30344-8 |
| Description | 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. |