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The longitudinal course of pediatric acute respiratory distress syndrome and its time to resolution: A prospective
Judith Ju Ming Wong1,2, Herng Lee Tan1, Rehena Sultana3
1Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore.
Insights
The time to resolution of pediatric acute respiratory distress syndrome (PARDS) increases with disease severity. This respiratory-specific outcome, T_res, correlates with longer mechanical ventilation and hospital stays, offering a new metric for PARDS assessment.
Area of Science:
- Pediatric critical care medicine
- Respiratory medicine
- Clinical outcomes research
Background:
- The longitudinal course and short-term outcomes of pediatric acute respiratory distress syndrome (PARDS) require further elucidation.
- Oxygenation indices like OI and OSI are crucial for assessing PARDS severity.
- Understanding factors influencing PARDS resolution is vital for patient management.
Purpose of the Study:
- To describe the oxygenation index (OI) and oxygen saturation index (OSI) in mild, moderate, and severe PARDS over 28 days.
- To provide pilot data on the time to resolution of PARDS (T_res) as a short-term respiratory-specific outcome.
- To hypothesize and analyze the association of T_res with PARDS severity and clinical outcomes.
Main Methods:
- Prospective observational study of 121 children with PARDS.
- Daily trending of OI and OSI for 28 days.
- Analysis of T_res (defined by OI/OSI thresholds) and its association with mechanical ventilation duration, ICU/hospital length of stay, and ventilator/ICU-free days.
Main Results:
- OI and OSI differentiated PARDS severity in the first 7 days, but this distinction diminished thereafter.
- Median T_res was significantly longer in severe PARDS (7.5 days) compared to moderate (5 days) and mild (4 days) PARDS (p<0.001).
- Increased T_res was associated with longer mechanical ventilation, ICU, and hospital stays, and fewer ventilator/ICU-free days.
Conclusions:
- The duration of oxygenation defects in PARDS progressively increases with disease severity.
- Time to resolution (T_res) serves as a potential short-term, respiratory-specific outcome measure for PARDS.
- Further validation of T_res in external cohorts is warranted to complement conventional clinical outcomes.
Background:
The longitudinal course of patients with pediatric acute respiratory distress syndrome (PARDS) is not well described. In this study, we describe the oxygenation index (OI) and oxygen saturation index (OSI) in mild, moderate, and severe PARDS over 28 days and provide pilot data for the time to resolution of PARDS (T res), as a short-term respiratory-specific outcome, hypothesizing that it is associated with the severity of PARDS and clinical outcomes.
Methods:
This prospective observational study recruited consecutive patients with PARDS. OI and OSI were trended daily over 28 days. T res (defined as OI < 4 or OSI < 5.3 on 2 consecutive days) were described based on PARDS severity and analyzed with Poisson and logistic regression to determine its association with conventional outcomes [mechanical ventilation (MV) duration, intensive care unit (ICU) and hospital length of stay, 28-day ventilator-free days (VFD), and 28-day ICU-free days (IFD)].
Results:
There were 121 children included in this study, 33/121(27.3%), 44/121(36.4%), and 44/121(36.4%) in the mild, moderate, and severe groups of PARDS, respectively. OI and OSI clearly differentiated mild, moderate, and severe groups in the first 7days of PARDS; however, this differentiation was no longer present after 7days. Median T res was 4 (interquartile range: 3, 6), 5 (4, 7), and 7.5 (7, 11.5) days; p < 0.001 for the mild, moderate, and severe groups of PARDS, respectively. T res was associated with increased MV duration, ICU and hospital length of stay, and decreased VFD and IFD.
Conclusion:
The oxygenation defect in PARDS took progressively longer to resolve across the mild, moderate, and severe groups. T res is a potential short-term respiratory-specific outcome, which may be useful in addition to conventional clinical outcomes but needs further validation in external cohorts.
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