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Evaluating the Performance of the Pediatric Acute Lung Injury Consensus Conference Definition of Acute Respiratory Distress Syndrome*

Parvathaneni, Kaushik; Belani, Sanjay MD; Leung, Dennis MD; Newth, Christopher J. L. MD, FRCPC; Khemani, Robinder G. MD, MsCI

Pediatric Critical Care Medicine: January 2017 - Volume 18 - Issue 1 - p 17–25
doi: 10.1097/PCC.0000000000000945
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Objective: The Pediatric Acute Lung Injury Consensus Conference has developed a pediatric-specific definition of acute respiratory distress syndrome, which is a significant departure from both the Berlin and American European Consensus Conference definitions. We sought to test the external validity and potential impact of the Pediatric Acute Lung Injury Consensus Conference definition by comparing the number of cases of acute respiratory distress syndrome and mortality rates among children admitted to a multidisciplinary PICU when classified by Pediatric Acute Lung Injury Consensus Conference, Berlin, and American European Consensus Conference criteria.

Design: Retrospective cohort study.

Setting: Tertiary care, university-affiliated PICU.

Patients: All patients admitted between March 2009 and April 2013 who met inclusion criteria for acute respiratory distress syndrome.

Interventions: None.

Measurements and Main Results: Of 4,764 patients admitted to the ICU, 278 (5.8%) met Pediatric Acute Lung Injury Consensus Conference pediatric acute respiratory distress syndrome criteria with a mortality rate of 22.7%. One hundred forty-three (32.2% mortality) met Berlin criteria, and 134 (30.6% mortality) met American European Consensus Conference criteria. All patients who met American European Consensus Conference criteria and 141 (98.6%) patients who met Berlin criteria also met Pediatric Acute Lung Injury Consensus Conference criteria. The 137 patients who met Pediatric Acute Lung Injury Consensus Conference but not Berlin criteria had an overall mortality rate of 13.1%, but 29 had severe acute respiratory distress syndrome with 31.0% mortality. At acute respiratory distress syndrome onset, there was minimal difference in mortality between mild or moderate acute respiratory distress syndrome by both Berlin (32.4% vs 25.0%, respectively) and Pediatric Acute Lung Injury Consensus Conference (16.7% vs 18.6%, respectively) criteria, but higher mortality for severe acute respiratory distress syndrome (Berlin, 43.6%; Pediatric Acute Lung Injury Consensus Conference, 37.0%). Twenty-four hours after acute respiratory distress syndrome onset, the presence of severe acute respiratory distress syndrome (using either Berlin or Pediatric Acute Lung Injury Consensus Conference) was associated with nearly 50% mortality.

Conclusions: Applying the Pediatric Acute Lung Injury Consensus Conference definition of acute respiratory distress syndrome has the potential to significantly increase the number of acute respiratory distress syndrome patients identified, with a lower overall mortality rate. However, severe acute respiratory distress syndrome is associated with extremely high mortality, particularly if present at 24 hours after initial diagnosis.

1Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, CA.

2Department of Biological Sciences, Dana and David Dornsife College of Letters Arts and Sciences, University of Southern California, Los Angeles, CA.

3Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.

*See also p. 83.

Supported, in part, by University of Southern California Office of the Provost.

Mr. Parvathaneni received funding from the University of Southern California Office of the Provost. Dr. Newth received funding from Philips Healthcare Research and Medtronic. Dr. Khemani disclosed other support (student was supported by a research fellowship from the University of Southern California) and received funding from Nihon Kohden. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: rkhemani@chla.usc.edu

©2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies