Respiratory Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

Abstract

CONTEXT Respiratory dysfunction is a component of every organ failure scoring system developed, reflecting the significance of the lung in multiple organ dysfunction syndrome. However, existing systems do not reflect current practice and are not consistently evidence based. OBJECTIVE We aimed to review the literature to identify the components of respiratory failure associated with outcomes in children, with the purpose of developing an operational and evidence-based definition of respiratory dysfunction. DATA SOURCES Electronic searches of PubMed and Embase were conducted from 1992 to January 2020 by using a combination of medical subject heading terms and text words to define respiratory dysfunction, critical illness, and outcomes. STUDY SELECTION We included studies of critically ill children with respiratory dysfunction that evaluated the performance of metrics of respiratory dysfunction and their association with patient-centered outcomes. Studies in adults, studies in premature infants (≤36 weeks’ gestational age), animal studies, reviews and commentaries, case series with sample sizes ≤10, and studies not published in English in which we were unable to determine eligibility criteria were excluded. DATA EXTRACTION Data were abstracted into a standard data extraction form. RESULTS We provided binary (no or yes) and graded (no, nonsevere, or severe) definitions of respiratory dysfunction, prioritizing oxygenation and respiratory support. The proposed criteria were approved by 82% of members in the first round, with a score of 8 of 9 (interquartile range 7–8). LIMITATIONS Exclusion of non-English publications, heterogeneity across the pediatric age range, small sample sizes, and incomplete handling of confounders are limitations. CONCLUSIONS We propose definitions for respiratory dysfunction in critically ill children after an exhaustive literature review.

Definition, Incidence, and Epidemiology of Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

“…This suggests that significant entrainment of room air is unlikely for children on HFNC supported with HFNC at flow rates greater than or equal to 1.5 L/kg/min, indicating that prescribed F io 2 is likely similar to delivered F io 2 and is reasonable for calculating Sp o 2 /F io 2 ratio (24). Additionally, experts in ARDS suggested making adults on HFNC of greater than or equal to 30 L/minute eligible to be diagnosed with ARDS (25), and pediatric experts recently defined respiratory failure using our same HFNC thresholds of greater than or equal to 1.5 L/kg/min or greater than or equal to 30 L/min (26).…”

A insuficiência respiratória na pediatria: Uma síndrome notável

“…Os pacientes com fibrose cística enfrentam complicações digestivas significativas, como a doença do refluxo gastroesofágico (DRGE) e um maior risco de câncer colorretal. Essas complicações adicionais destacam a importância de um manejo multidisciplinar e um acompanhamento próximo para os pacientes com fibrose cística, visando prevenir e tratar essas condições com eficácia (Ley, 2022;Yehya et al, 2022).…”