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Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS

Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS

Published on: April 7, 2021

Definition and global epidemiology of pediatric acute respiratory distress syndrome

Fernando Beltramo¹, Robinder G Khemani¹

¹Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.

Annals of Translational Medicine

|November 16, 2019

Insights

The 2015 Pediatric Acute Lung Injury Consensus Conference (PALICC) definition for pediatric ARDS (PARDS) reflects current practice, but severity alone doesn't predict outcomes. Continued research is needed for better risk stratification in pediatric ARDS.

Area of Science:

Pediatric critical care medicine
Respiratory medicine
Pediatric pulmonology

Background:

Pediatric Acute Respiratory Distress Syndrome (PARDS) has evolved since initial descriptions.
The 2015 Pediatric Acute Lung Injury Consensus Conference (PALICC) established specific diagnostic criteria for PARDS.
Key changes included simplified radiography, pulse oximetry, non-invasive ventilation criteria, and oxygenation index (OI) use.

Purpose of the Study:

To evaluate the impact of the 2015 PALICC definition on PARDS epidemiology.
To assess the correlation between PARDS severity and clinical outcomes.
To determine if the new definition aligns with current clinical practices.

Main Methods:

Literature review of studies published after the 2015 PALICC definition.
Analysis of epidemiological trends in pediatric ARDS.
Assessment of the relationship between PARDS severity metrics and patient outcomes.

Main Results:

Despite definition changes, core epidemiological elements of PARDS have remained stable over two decades.
The PALICC definition appears to align with contemporary clinical practices.
PARDS severity, as defined by PALICC, is insufficient for predicting mortality and other outcomes, though severe hypoxemia shows some association.

Conclusions:

The 2015 PALICC definition for PARDS is a valuable tool reflecting current practice.
Further research is necessary to refine outcome prediction beyond current severity metrics.
Improved risk stratification models are needed for pediatric ARDS patients.

Read full analysis

Abstract:

Acute respiratory distress syndrome (ARDS) has been known to occur in children since early descriptions of the disease, but pediatric specific diagnostic criteria were first established in 2015 with the Pediatric Acute Lung Injury Consensus Conference (PALICC) definition of pediatric ARDS (PARDS). There were substantial changes proposed with the PALICC definition, including simplification of radiographic criteria, use of pulse oximetry based metrics to define PARDS, specific criteria for non-invasive ventilation, and the use of oxygenation index (OI) instead of PaO2/FiO2 ratio for those on invasive ventilation. While these changes could potentially result in major changes in the reported incidence and outcome of PARDS, review of the recent literature since publication of the PALICC definitions highlight that major elements regarding the contemporary epidemiology of PARDS have remained stable over the past 20 years. This highlights that the PARDS definition is likely catching up to changes in clinical practice, and suggests that this new definition should be used moving forward as it is more reflective of current practice than historical definitions. However, it is also clear that PARDS severity alone (as measured by the PALICC) criteria insufficiently characterizes the risk for mortality or other important clinical outcomes amongst PARDS patients, although there appears to be some association between PARDS severity and outcome, particularly when hypoxemia is severe.

Keywords:

Pediatric Acute Lung Injury Consensus Conference (PALICC)Pediatric acute respiratory distress syndrome (PARDS)acute respiratory distress syndrome (ARDS)definition epidemiology

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