Acute Respiratory Distress Syndrome Definitions in Adults and Children: A Comparative Narrative Review

Area of Science:

• Critical Care Medicine
• Pulmonology
• Pediatric Critical Care

Background:

• Acute Respiratory Distress Syndrome (ARDS) is a severe respiratory failure with diverse etiologies.
• Adult ARDS definitions evolved to the 2024 Berlin 2.0, while pediatric ARDS (PARDS) criteria were updated in 2023 by PALICC-2.
• Both definitions address severe pulmonary endothelial inflammation.

Purpose of the Study:

• To compare the latest adult (Berlin 2.0) and pediatric (PALICC-2) definitions for Acute Respiratory Distress Syndrome.
• To identify convergences and distinctions in diagnostic criteria.
• To explore implications for research and clinical practice.

Main Methods:

• A narrative literature review of consensus statements and key studies.
• Comparison of Berlin 2.0 and PALICC-2 definitions across key domains.
• Analysis included timing, imaging, oxygenation, comorbidities, ventilation, and resource limitations.

Main Results:

• Both definitions incorporate non-invasive indices and are adaptable to resource-limited settings.
• Pediatric criteria utilize Oxygenation Index (OI) or Oxygen Saturation Index (OSI) for invasively ventilated patients.
• Key differences exist in imaging requirements (bilateral vs. unilateral findings) and inclusion of chronic comorbidities.

Conclusions:

• Berlin 2.0 and PALICC-2 represent advancements in global ARDS definitions.
• Remaining physiologic and structural differences impact prognosis and research.
• Harmonization is essential for cross-age comparability, clinical trial design, and improved patient outcomes.