Comparison of Prevalence and Outcomes of Pediatric Acute Respiratory Distress Syndrome Using Pediatric Acute Lung Injury Consensus Conference Criteria and Berlin Definition

Abstract

ObjectivesOur objective was to compare the prevalence and outcomes of pediatric acute respiratory distress syndrome using the Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria and Berlin definitions.MethodsWe screened case records of all children aged 1 month to 17 years of age admitted to the Pediatric Intensive Care Unit (PICU) over a 3-year period (2015–2017) for presence of any respiratory difficulty at admission or during PICU stay. We applied both PALICC and Berlin criteria to these patients. Data collection included definition and outcome related variables. Data were compared between the “PALICC only group” and the “Berlin with or without PALICC” group using Stata 11.ResultsOf a total of 615 admissions, 246 were identified as having respiratory difficulty at admission or during PICU stay. A total of 61 children (prevalence 9.9%; 95% CI: 7.8–12.4) fulfilled the definition of acute respiratory distress syndrome (ARDS) with either of the two criteria. While 60 children (98%) fulfilled PALICC criteria, only 26 children (43%) fulfilled Berlin definition. There was moderate agreement between the two definitions (Kappa: 0.51; 95% CI: 0.40–0.62; observed agreement 85%). Greater proportion of patients had severe ARDS in the “Berlin with or without PALICC group” as compared to the “PALICC only” group (50 vs. 19%). There was no difference between the groups with regard to key clinical outcomes such as duration of ventilation (7 vs. 8 days) or mortality [51.4 vs. 57.7%: RR (95% CI): 0.99 (0.64–1.5)].ConclusionIn comparison to Berlin definition, the PALICC criteria identified more number of patients with ARDS. Proportion with severe ARDS and complications was greater in the “Berlin with or without PALICC” group as compared to the “PALICC only” group. There were no differences in clinical outcomes between the groups.

The Current State of Pediatric Acute Respiratory Distress Syndrome

“…The PALICC criteria were recently compared to prior definitions (Berlin, AECC) in 2 studies of pediatric patients in the intensive care unit (ICU). 7,8 Both studies concluded that the new criteria identified a higher number of PARDS patients. In addition, when compared to Berlin and AECC definitions, patients meeting PALICC criteria for PARDS were found to have a lower overall mortality rate 7 and a lower proportion of severe ARDS and complications.…”

“…In addition, when compared to Berlin and AECC definitions, patients meeting PALICC criteria for PARDS were found to have a lower overall mortality rate 7 and a lower proportion of severe ARDS and complications. 8 Even more recently, the prospective international Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) study, the largest PARDS study using the PALICC definition, demonstrated in over 700 children that the PALICC definition identified more children as having PARDS than the Berlin definition. 9 Notably, capturing more patients with milder forms of PARDS with the broader definition may have serious implications on future outcome studies if they are not stratified by disease severity.…”

“…Respiratory failure is the most common cause of death for children admitted to pediatric intensive care units (PICUs), 10 and ARDS accounts for 1%-10% of PICU admissions. 7,8,11 Mortality rates in PARDS are highly variable across studies, likely attributable to varying comorbid conditions and different etiologies. 11 A meta-analysis by Wong et al found the pooled mortality rate in PARDS to be *24%, with an overall downtrend in mortality over the last 3 decades.…”

High flow nasal cannula vs non-invasive ventilation in pediatric ARDS: an RCT

“…A prevalence of 9.9% was found in another study [3], which enrolled patients fulfilling the PARDS criteria defined by the PALICC [2].…”

“…It has been re-defined (2015), in children, as per the final recommendations of the Pediatric Acute Lung Injury Consensus Conference (PALICC) [2]. Prevalence of PARDS (Pediatric acute respiratory Distress Syndrome) as it is now known as, has been found to be upto 9.9% in a recent study [3]. The use of high flow nasal cannula is a promising treatment but its efficacy compared with non invasive ventilation (NIV) in management of PARDS or acute hypoxemic respiratory failure [4] is not known [5,6].…”