Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2)

Abstract

OBJECTIVES: We sought to update our 2015 work in the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PARDS), considering new evidence and topic areas that were not previously addressed. DESIGN: International consensus conference series involving 52 multidisciplinary international content experts in PARDS and four methodology experts from 15 countries, using consensus conference methodology, and implementation science. SETTING: Not applicable. PATIENTS: Patients with or at risk for PARDS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Eleven subgroups conducted systematic or scoping reviews addressing 11 topic areas: 1) definition, incidence, and epidemiology; 2) pathobiology, severity, and risk stratification; 3) ventilatory support; 4) pulmonary-specific ancillary treatment; 5) nonpulmonary treatment; 6) monitoring; 7) noninvasive respiratory support; 8) extracorporeal support; 9) morbidity and long-term outcomes; 10) clinical informatics and data science; and 11) resource-limited settings. The search included MEDLINE, EMBASE, and CINAHL Complete (EBSCOhost) and was updated in March 2022. Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to summarize evidence and develop the recommendations, which were discussed and voted on by all PALICC-2 experts. There were 146 recommendations and statements, including: 34 recommendations for clinical practice; 112 consensus-based statements with 18 on PARDS definition, 55 on good practice, seven on policy, and 32 on research. All recommendations and statements had agreement greater than 80%. CONCLUSIONS: PALICC-2 recommendations and consensus-based statements should facilitate the implementation and adherence to the best clinical practice in patients with PARDS. These results will also inform the development of future programs of research that are crucially needed to provide stronger evidence to guide the pediatric critical care teams managing these patients.

Dornase alfa in mechanically ventilated children with bronchiolitis: A retrospective cohort study

“…The Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) group recommends oxygenation index (OI) to be the primary metric for lung disease severity in pediatric acute respiratory distress syndrome. 18 Oxygen saturation index (OSI) is an alternative calculation that replaces PaO2 with SpO2 measured by pulse oximeter, which is noninvasive and more readily available. 19 With the challenges associated with obtaining and maintaining arterial lines in pediatric patients, OSI is becoming an increasingly more popular replacement metric for risk stratification of lung disease severity.…”

“…Given there is no universally accepted or validated severity score for mechanically ventilated pediatric patients with bronchiolitis, we evaluated OSI as a surrogate marker for severity of illness. The Second Pediatric Acute Lung Injury Consensus Conference (PALICC‐2) group recommends oxygenation index (OI) to be the primary metric for lung disease severity in pediatric acute respiratory distress syndrome 18 . Oxygen saturation index (OSI) is an alternative calculation that replaces PaO2 with SpO2 measured by pulse oximeter, which is noninvasive and more readily available 19 .…”

“…With the challenges associated with obtaining and maintaining arterial lines in pediatric patients, OSI is becoming an increasingly more popular replacement metric for risk stratification of lung disease severity 20 . OSI has been found to be an adequate surrogate marker replacement for OI in mechanically ventilated infants and children and is recommended by the PALICC‐2 group to be used for stratification of patients with respiratory failure when OI is not available 18,21,22 …”

Editor’s Choice Articles for June

“…For example, think about what we should now know and consider as a limitation when reading a report that imputes arterial partial pressure of oxygen to fractional inspired oxygen (F io 2 ) ratio from Sp o 2 /F io 2 values. The same limitation applies to replacing the “oxygenation index” with the “oxygen saturation index” (11–13), which I challenge our researchers to now resolve.…”

Noninvasive Ventilation for Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study*

“…Therefore, it is crucial to identify additional characteristics of hypoxemic children where the likelihood of NIV failure is high, and the risk of NIV may outweigh potential benefits. Recently, the second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) highlighted the limited evidence on NIV use in PARDS, emphasizing the need for further research (14, 15). Therefore, as a planned ancillary study of the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) study (16), we aimed to describe contemporary use of NIV in PARDS.…”