1. Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study
- Author
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Robinder G Khemani, Lincoln Smith, Yolanda M Lopez-Fernandez, Jeni Kwok, Rica Morzov, Margaret J Klein, Nadir Yehya, Douglas Willson, Martin C J Kneyber, Jon Lillie, Analia Fernandez, Christopher J L Newth, Philippe Jouvet, Neal J Thomas, Eugenia Abaleke, Kate G Ackerman, Carlos Acuña, Michelle Adu-Darko, Jeremy T Affolter, Rachel Agbeko, Ahmed Al Amoudi, Ahmad Alahmadti, Nedaa Aldairi, Omar Alibrahim, Kiona Allen, Christine Allen, Awni Al-Subu, María Althabe, Jimena Alvear, Ayse Berna Anil, Heather Anthony, Angela Aramburo, David Arjona Villanueva, Neda Ashtari, Antonio Ávila Vera, Paul Baines, Melissa Bales, Samantha Barr, Dana Barry, Florent Baudin, John Beca, Holly Belfield, Fernando Beltramo, Laura Benken, Anoopindar Bhalla, Andrea Blom, Priscila Botta, Pierre Bourgoin, Marta Brezmes, George Briassoulis, Armelle Bridier, Joe Brierley, Sonia Brio Sanagustin, Elizabeth Broden, Warwick Butt, Kris Bysani, Cristina Camilo, Anna Camporesi, Santiago Campos-Miño, Fulya Kamit Can, Patricia Capocasa, Daniel Caro I, Christopher Carroll, Pablo Castellani, Andres E. Castillo, Yang Chen, Ranjit S. Chima, Fabrizio Chiusolo, Karina Cinquegrani, Bria Coates, Alvaro Coronado-Munoz, Ambar Cortéz, Pablo Cruces Romero, Melissa Cullimore, Natalie Cvijanovich, Mary K. Dahmer, Akash Deep, Carmel Delzoppo, Matteo Di Nardo, Franco Díaz, Sandra Dijkstra, W. Keith Dockery, Troy E. Dominguez, Mariana Dumitrascu, Oguz Dursun, Buvana Dwarakanathan, Ismail Elghuwael, Guillaume Emeriaud, Simon Erickson, Segundo Fernando Español, Jim Brian Estil, Calandra Feather, Yael Feinstein, Analía Fernández, Marcela Ferreyra, Heidi Flori, Yanina Vanesa Fortini, Peter-Marc Fortune, Mary Ellen French, Mirella Gaboli, Helen Gale, Paula García Casas, Maria García González, Richa Gautam, Rainer Gedeit, Mathieu Genuini, Shira Gertz, Martin Giampieri, Carlos Gil Escobar, John S. Giuliano Jr, Loreto Godoy Mundaca, Concepción Goni Orayen, Jose Manuel Gonzalez Gomez, Beatriz Govantes, Julie Guichoux, Gustavo Alfredo Guzman Rivera, Bereketeab Haileselassie, Yong Y Han, Amy Harrell, Silvia Hartmann, Tarek Hazwani, Glenda Hefley, Grace Henderson, Deyin D. Hsing, Amber Hughes-Schalk, Janet Hume, Stavroula Ilia, David Inwald, Thomas Iolster, Ledys María Izquierdo, Shirin Jafari-Namin, Nancy Jaimon, Alberto E Jarillo Quijada, J. Dean Jarvis, Chaandini Jayachandran, Claire Jennings, Asumthia S. Jeyapalan, Nestor Javier Jimenez Rivera, Dawn Jones, Mary Kasch, Jane't Keary, Connor Kelley, Aaron Kessel, Robinder Khemani, Yoshiko Kida, Caroline King, Martin Kneyber, Allison Kniola, Kelli Krallman, Sherri Kubis, Lucinda Kustka, Michihito Kyo, Luis Martín Landry, Samir Latifi, Angela Lawton-Woodhall, John C. Lin, Ana M. Llorente de la Fuente, Yurika Paola Lopez Alarcón, Yolanda López Fernández, Jesús Lopez-Herce, Lucy Chai See Lum, Duncan Macrae, Aline B. Maddux, Paula Madurga Revilla, Sidharth Mahapatra, Matthieu Maria, Lidia Martínez, Amelia Martinez de Azagra, Alejandro Fabio Martínez León, Liliana Mazzillo Vega, Jenni McCorkell, Karen McIntyre, Tania Medina, Alberto Medina, Christie Mellish, Mikel Mendizabal, Courtney Merritt, Reinout Mildner, Christophe Milesi, Vicent Modesto I Alapont, Cecilia Monjes, Tracey Monjure, María José Montes, Antonio Morales Martinez, Ryan Morgan, Peter M. Mourani, Kathy Murkowski, Marie Murphy, Natalie Napolitano, Dan Nerheim, Sholeen T. Nett, Christopher Newth, Ryan Nofziger, Maria Jose Nunez, Shinichiro Ohshimo, Eider Onate Vergara, Ebru A Ongun, Daniel Orqueda, Siva Oruganti, Izabela Pagowska-Klimek, Daniel Palanca Arias, Jon Pappachan, Rosalba Pardo Carrero, Margaret M. Parker, Julio Parrilla, Nikhil Patankar, Paula Pávez Madrid, Valerie Payen, Fernando Paziencia, Claudia Pedraza, Germán Perez Lozano, Javier Pilar Orive, Byron Enrique Piñeres Olave, Alyssa Pintimalla, Neethi Pinto, Adrian Plunkett, Steve Pon, Marti Pons Odena, Rossana Poterala, Haiping Qiao, Deyanira Quiñonez Lopez, Kimberly Ralston, Grimaldo Ramirez Cortez, Anna Ratiu, Miriam Rea, Susana Reyes Dominguez, Chiara Rodgers, Patricia Rodriguez Campoy, Laurie Ronan, Deheza Rosemary, Courtney Rowan, Kalaimaran Sadasivam, Juan Ignacio Sanchez Diaz, Ron Sanders, James Santanelli, Anil Sapru, James Schneider, Jesica Sforza, Sara Shea, Steven L. Shein, Claire Sherring, Victoria Sheward, Nobuaki Shime, Avani Shukla, Alejandro Siaba Serrate, Yamila Sierra, Lindsay Sikora, Catarina Silvestre, Marcy Singleton, Daniel Sloniewsky, Rebecca Smith, Hanqiu Song, Marta Sousa Moniz, Michael Spaeder, Debbie Spear, Philip Spinella, Julie Starck, Erin Stoneman, Felice Su, Gayathri Subramanian, Erin Sullivan, Santosh Sundararajan, Todd Sweberg, Kim Sykes, Yuichi Tabata, Chian Wern Tai, Joana Tala, Swee Fong Tang, José Tantalean, Ryan Taylor, Neal Thomas, Shane Tibby, Kelly S Tieves, Luis Torero, Silvio Fabia Torres, Balagangadhar Totapally, Brendan Travert, Edward Truemper, Gonzalo Turón, Katri Typpo, Juan Ramón Valle, Sonia I Vargas G, Pablo Vasquez Hoyos, Daniel Vasquez Miranda, Martin Vavrina, Nilda Águeda Vidal, Manpreet Virk, Laura Walsh, Adriana Wegner Araya, James Weitz, Lawren Wellisch, Paul Wellman, Katherine Woods, Rocio Yerovi, Toni Yunger, Cesar Zuluaga Orrego, Jiri Zurek, and Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Internationality ,Cross-sectional study ,Acute Lung Injury ,Kaplan-Meier Estimate ,Lung injury ,Intensive Care Units, Pediatric ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Sex Factors ,Anesthesiology ,Cause of Death ,Epidemiology ,Severity of illness ,Medicine ,Humans ,030212 general & internal medicine ,Hospital Mortality ,Prospective Studies ,Prospective cohort study ,Child ,Cause of death ,Respiratory Distress Syndrome ,business.industry ,Incidence (epidemiology) ,Age Factors ,Prognosis ,Combined Modality Therapy ,Survival Analysis ,United States ,Cross-Sectional Studies ,030228 respiratory system ,Area Under Curve ,Child, Preschool ,Emergency medicine ,Female ,business - Abstract
Summary 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. Funding University of Southern California Clinical Translational Science Institute, Sainte Justine Children's Hospital, University of Montreal, Canada, Reseau en Sante Respiratoire du Fonds de Recherche Quebec-Sante, and Children's Hospital Los Angeles, Department of Anesthesiology and Critical Care Medicine.
- Published
- 2018