Acute Respiratory Distress Syndrome Following Pediatric Trauma: Application of Pediatric Acute Lung Injury Consensus Conference Criteria

Abstract

Objective: To assess the incidence, severity, and outcomes of pediatric acute respiratory distress syndrome (PARDS) following trauma using Pediatric Acute Lung Injury Consensus Conference criteria Design: Retrospective cohort study Setting: Level 1 pediatric trauma center Patients: Trauma patients ≤17 years admitted to the intensive care unit from 2009-2017 Interventions: None Measurements and Main Results:We queried electronic health records to identify patients meeting PARDS oxygenation criteria for ≥6 hours and determined whether patients met complete PARDS criteria via chart review. We estimated associations between PARDS and outcome using generalized linear Poisson regression adjusted for age, injury mechanism, Injury Severity Score, and serious brain and chest injuries. Of 2470 critically injured children, 103 (4.2%) met PARDS criteria. Mortality was 34.0% among PARDS patients versus 1.7% among non-PARDS patients (adjusted RR 3.7, 95% CI 2.0-6.9). Mortality was 50.

Pathobiology, Severity, and Risk Stratification of Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

“…Since PALICC, many studies have corroborated the impact of previously identified comorbidities—most notably immunodeficiency (1–21)—and PARDS triggers (22–81) on severity of PARDS or PARDS outcomes. It remains clear that both comorbidities and the many conditions that cause PARDS contribute to the heterogeneity seen in this syndrome.…”

“…Furthermore, there has yet to be an effective pharmacologic treatment for PARDS, and care is supportive. In addition, PARDS is a heterogeneous condition due in part to differences among children in the underlying pathobiology, age (which impacts changes in the lungs, chest wall, and immune system associated with development), comorbidities (1–21), and inciting trigger (22–85).…”

Traumatic brain injury in children with thoracic injury: clinical significance and impact on ventilatory management

“…The incidence of ARDS was very low in our cohort, and that could be explained by two reasons. First, the retrospective design did not allow us to precisely assess the Berlin criteria a posteriori while ARDS is probably underestimated and underreported [ 6 ]. Second, as assessed by the trauma severity scores we used, patients included in our cohort are overall less severe than patients reported in other observational studies [ 17 , 20 ].…”

Risk Factors for Positive Post-Traumatic Stress Disorder Screening and Associated Outcomes in Children Surviving Acute Respiratory Failure: A Secondary Analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure Clinical Trial

“…Iatrogenic withdrawal syndrome was defined as having a highest daily Withdrawal Assessment Tool-1 score greater than or equal to 3 (23). Pediatric Acute Respiratory Distress Syndrome (PARDS) severity was defined using the Pediatric Acute Lung Injury Consensus Conference criteria (24). Multiple Organ Dysfunction Syndrome (MODS) was defined as one or more extrapulmonary organ dysfunctions.…”