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Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study
- Source :
- The Lancet Respiratory Medicine, 7(2), 115-128. ELSEVIER SCI LTD
- Publication Year :
- 2018
-
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.
- Subjects :
- 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
Subjects
Details
- ISSN :
- 22132619 and 22132600
- Volume :
- 7
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- The Lancet. Respiratory medicine
- Accession number :
- edsair.doi.dedup.....9ab0d58c10ee34c0dff5b4e4677b5b6e