Allergy Asthma Respir Dis.  2019 Jan;7(1):44-50. 10.4168/aard.2019.7.1.44.

Clinical application of the Pediatric Acute Lung Injury Consensus Conference definition of acute respiratory distress syndrome

Affiliations
  • 1Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea. sophi1@yuhs.ac
  • 2Sowha Children's Hospital, Seoul, Korea.

Abstract

PURPOSE
Despite improved quality of intensive care, acute respiratory distress syndrome (ARDS) significantly contributes to mortality in critically ill children. As pre-existing definitions of ARDS were adult-oriented standards, the Pediatric Acute Lung Injury Consensus Conference (PALICC) group released a new definition of pediatric ARDS. In this study, we aimed to assess the performance of PALICC definition for ARDS risk stratification.
METHODS
Total 332 patients who admitted to the intensive care unit at Severance Hospital from January 2009 to December 2016 and diagnosed as having ARDS by either the PALICC definition or the Berlin definition were retrospectively analyzed. Patient characteristics and mortality rates were compared between the individual severity groups according to both definitions.
RESULTS
The overall mortality rate was 36.1%. The mortality rate increased across the severity classes according to both definitions (26% in mild, 37% in moderate and 68% in severe by the PALICC definition [P<0.001]; 20% in mild, 32% in moderate and 64% in severe by the Berlin definition [P<0.001]). The mortality risk increased only for severe ARDS in both definitions (hazard ratio [95% confidence interval]: 2.279 [1.414-3.672], P=0.001 by the PALICC definition; 2.674 [1.518-4.712], P=0.001 by the Berlin definition). There was no significant difference in mortality discrimination between the 2 definitions (difference in integrated area under the curve: 0.017 [−0.018 to 0.049]).
CONCLUSION
The PALICC definition demonstrated similar discrimination power on PARDS' severity and mortality as the Berlin definition.

Keyword

Pediatric acute respiratory distress syndrome; Pediatric Acute Lung Injury Consensus Conference; Berlin definition; Mortality

MeSH Terms

Acute Lung Injury*
Berlin
Child
Consensus*
Critical Care
Critical Illness
Discrimination (Psychology)
Humans
Intensive Care Units
Mortality
Respiratory Distress Syndrome, Adult*
Retrospective Studies

Figure

  • Supplementary Fig. 1. Distribution of patients according to Pediatric Acute Lung Injury Consensus Conference (PALICC) and Berlin definition. PARDS, pediatric acute respiratory distress syndrome.

  • Fig. 2. Kaplan-Meier survival curves for mortality according to Pediatric Acute Lung Injury Consensus Conference (PALICC) (A) and Berlin definition severity group (B). (A) Black line represents mild acute respiratory distress syndrome (ARDS), gray line represents moderate ARDS, and light gray line represents severe ARDS. (B) Black, gray, and light gray lines represent mild, moderate, and severe ARDS, respectively.

  • Fig. 3. Predictive accuracy for mortality: integrated area under the curve (iAUC) by follow-up time. Solid and dotted lines represent the Pediatric Acute Lung Injury Consensus Conference (PALICC) and Berlin definition respectively.


Reference

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