Relevant Outcomes in Pediatric Acute Respiratory Distress Syndrome Studies

Abstract

Despite distinct epidemiology and outcomes, pediatric acute respiratory distress syndrome (PARDS) is often managed based on evidence extrapolated from treatment of adults. The impact of non-pulmonary processes on mortality as well as the lower mortality rate compared to adults with acute respiratory distress syndrome (ARDS) renders the utilization of short-term mortality as a primary outcome measure for interventional studies problematic. However, data regarding alternatives to mortality are profoundly understudied, and proposed alternatives, such as ventilator-free days, may be themselves subject to hidden biases. Given the neuropsychiatric and functional impairment in adult survivors of ARDS, characterization of these morbidities in children with PARDS is of paramount importance. The purpose of this review is to frame these challenges in the context of the existing pediatric literature, and using adult ARDS as a guide, suggest potential clinically relevant outcomes that deserve further investigation. The goal is to identify important areas of study in order to better define clinical practice and facilitate future interventional trials in PARDS.

Association of Response to Inhaled Nitric Oxide and Duration of Mechanical Ventilation in Pediatric Acute Respiratory Distress Syndrome*

“…Our mortality results agree with those of previous studies[4-10], though it has been argued that mortality in PARDS is usually secondary to non-pulmonary causes, making it unsurprising that improved oxygenation would have little effect on overall mortality[28]. However, previous studies did not evaluate for morbidity effects and selectively excluded certain populations of patients—such as those with immunocompromise, sepsis, and multisystem organ dysfunction—from analysis, which limits generalizability of the results to a significant portion of PICU patients[29, 30].…”

Oxygenation Index in the First 24 Hours after the Diagnosis of Acute Respiratory Distress Syndrome as a Surrogate Metric for Risk Stratification in Children

“…Patients who required ≥28 ventilator days and all ICU non-survivors were designated as VFD=0. This composite endpoint, which incorporates both mortality and length of ventilation by penalizing non-survivors, is among the most commonly used surrogate endpoints in recent PARDS studies [18].…”

Markers of pediatric respiratory distress predictive of poor outcome in low- and middle-income countries: a systematic review

“…[78][79][80] We did not find a trend toward reporting nonmortality outcomes as income level increased, in contrast to high-income countries that have transitioned to reporting predominantly non-mortality outcomes. [81][82][83] This could reflect high mortality rates in upper middle income countries, making death still the most relevant outcome. Alternatively, it may reflect differences in facility-level resources and mortality risk independent of country income level, given known differences in within-country resource availability and access to care.…”