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Definition, Incidence, and Epidemiology of Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric
Nadir Yehya1,2, Lincoln Smith3, Neal J Thomas4
1Division of Pediatric Critical Care, Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA.
Insights
Updated definitions for pediatric acute respiratory distress syndrome (PARDS) were developed by experts. These revised consensus statements incorporate new evidence to refine PARDS diagnosis and related conditions.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Clinical Epidemiology
Background:
- The initial pediatric acute respiratory distress syndrome (PARDS) definitions were established in 2015 by the Pediatric Acute Lung Injury Consensus Conference (PALICC).
- These definitions have been utilized in numerous studies, necessitating an update based on accrued data.
- The Second PALICC (PALICC-2) convened experts to reassess and refine the PARDS definition.
Purpose of the Study:
- To identify and summarize evidence concerning the definition and epidemiology of PARDS.
- To modify and update the existing definitions for PARDS, "Possible PARDS," and "At-Risk for PARDS."
- To enhance the construct validity and clinical utility of PARDS definitions.
Main Methods:
- A systematic literature search was conducted across MEDLINE, Embase, and CINAHL Complete.
- Studies involving pediatric subjects with or at risk for PARDS were included, with specific exclusions for adult-focused research.
- Evidence was synthesized using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, with 97 studies selected for data extraction.
Main Results:
- Seventeen consensus-based definition statements were formulated, updating the criteria for PARDS, "Possible PARDS," and "At-Risk for PARDS."
- The review encompassed various aspects of PARDS definition, including age, timing, imaging, oxygenation, respiratory support, and comorbidities.
- Epidemiological data relevant to the updated definitions were also summarized.
Conclusions:
- Updated, data-informed consensus statements for the definition of PARDS have been established.
- The revised definitions aim to improve the accuracy and consistency of PARDS diagnosis in pediatric populations.
- These updated statements provide a refined framework for research and clinical practice in pediatric acute respiratory distress syndrome.
Objectives:
In 2015, the Pediatric Acute Lung Injury Consensus Conference (PALICC) provided the first pediatric-specific definitions for acute respiratory distress syndrome (pediatric acute respiratory distress syndrome [PARDS]). These definitions have since been operationalized in cohort and interventional PARDS studies. As substantial data have accrued since 2015, we have an opportunity to assess the construct validity and utility of the initial PALICC definitions. Therefore, the Second PALICC (PALICC-2) brought together multiple PARDS experts and aimed to identify and summarize relevant evidence related to the definition and epidemiology of PARDS and create modifications to the definition of PARDS.
Data Sources:
MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost).
Study Selection:
We included studies of subjects with PARDS, or at risk for PARDS, excluding studies pertaining primarily to adults except as specified for identifying age-specific cutoffs.
Data Extraction:
Title/abstract review, full-text review, and data extraction using a standardized data collection form.
Data Synthesis:
The Grading of Recommendations Assessment, Development, and Evaluation approach was used to identify and summarize evidence and develop recommendations. A total of 97 studies were identified for full-text extraction addressing distinct aspects of the PARDS definition, including age, timing, imaging, oxygenation, modes of respiratory support, and specific coexisting conditions. Data were assessed in a Patient/Intervention/Comparator/Outcome format when possible, and formally summarized for effect size, risk, benefit, feasibility of implementation, and equity. A total of 17 consensus-based definition statements were made that update the definition of PARDS, as well as the related diagnoses of "Possible PARDS" and "At-Risk for PARDS." These statements are presented alongside a summary of the relevant epidemiology.
Conclusions:
We present updated, data-informed consensus statements on the definition for PARDS and the related diagnoses of "Possible PARDS" and "At-Risk for PARDS."
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