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ABSTRACT 481

COMPARING PAO2 AND SPO2 BASED DEFINITIONS FOR PEDIATRIC ACUTE REPIRATORY DISTRESS SYNDROME

Wong, J.J.M.1; Loh, T.F.2; Testoni, D.3; Yeo, J.G.2; Mok, Y.H.2; Lee, J.H.2

Pediatric Critical Care Medicine: May 2014 - Volume 15 - Issue 4_suppl - p 110
doi: 10.1097/01.pcc.0000449207.96808.f9
Abstracts of the 7th World Congress on Pediatric Critical Care
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1Pediatric Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore 2Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore, Singapore 3Duke Clinical Research Institute, Duke University Medical Center, Durham, USA

Background and aims: The most accepted definition for acute respiratory distress syndrome (ARDS) remains the American-European Consensus Conference (AECC) definition. Other proposed definitions include the Berlin definition, SpO2:FiO2 ratio (S/F ratio), oxygenation index (OI), and oxygenation saturation index (OSI).

Aims: Our aim is to compare these definitions with regard to reclassification of children with ARDS.

Methods: We identified patients with ARDS (based on AECC’s definition) between 2009 and 2012. The Institutional Review Board approved this study. The following cutoffs were used.

Table

Table

Results: 26 patients were identified. ARDS incidence was 6.3/1000 of PICU admissions. Median age was 8.3years (4 days-17 years). Median PRISM2 score was 6.4 (0.7–86.3). Overall mortality was 62%. 51 arterial blood gas and saturation readings were analyzed. The Berlin definition for moderate-severe ARDS did not change any classification. On day 1, the S/F ratio identified all cases of ALI and ARDS but the OI and OSI reclassified one and two patients from ARDS to ALI respectively. On day 2, S/F ratio, OI and OSI reclassified two patients with normal P/F ratios into either ALI or ARDS. These patients were on excessively high FiO2. Conclusions: AECC and Berlin definition identified the same patients. SpO2 based markers overestimate lung injury when excessively high FiO2 is used. Further studies on these definitions are needed.

©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies