Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study

Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology (PARDIE) Investigators, Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Paediatric acute respiratory distress syndrome (PARDS) is associated with high mortality in children, but until recently no paediatric-specific diagnostic criteria existed. The Pediatric Acute Lung Injury Consensus Conference (PALICC) definition was developed to overcome limitations of the Berlin definition, which was designed and validated for adults. We aimed to determine the incidence and outcomes of children who meet the PALICC definition of PARDS. Methods: In this international, prospective, cross-sectional, observational study, 145 paediatric intensive care units (PICUs) from 27 countries were recruited, and over a continuous 5 day period across 10 weeks all patients were screened for enrolment. Patients were included if they had a new diagnosis of PARDS that met PALICC criteria during the study week. Exclusion criteria included meeting PARDS criteria more than 24 h before screening, cyanotic heart disease, active perinatal lung disease, and preparation or recovery from a cardiac intervention. Data were collected on the PICU characteristics, patient demographics, and elements of PARDS (ie, PARDS risk factors, hypoxaemia severity metrics, type of ventilation), comorbidities, chest imaging, arterial blood gas measurements, and pulse oximetry. The primary outcome was PICU mortality. Secondary outcomes included 90 day mortality, duration of invasive mechanical and non-invasive ventilation, and cause of death. Findings: Between May 9, 2016, and June 16, 2017, during the 10 study weeks, 23 280 patients were admitted to participating PICUs, of whom 744 (3·2%) were identified as having PARDS. 95% (708 of 744) of patients had complete data for analysis, with 17% (121 of 708; 95% CI 14–20) mortality, whereas only 32% (230 of 708) of patients met Berlin criteria with 27% (61 of 230) mortality. Based on hypoxaemia severity at PARDS diagnosis, mortality was similar among those who were non-invasively ventilated and with mild or moderate PARDS (10–15%), but higher for those with severe PARDS (33% [54 of 165; 95% CI 26–41]). 50% (80 of 160) of non-invasively ventilated patients with PARDS were subsequently intubated, with 25% (20 of 80; 95% CI 16–36) mortality. By use of PALICC PARDS definition, severity of PARDS at 6 h after initial diagnosis (area under the curve [AUC] 0·69, 95% CI 0·62–0·76) discriminates PICU mortality better than severity at PARDS diagnosis (AUC 0·64, 0·58–0·71), and outperforms Berlin severity groups at 6 h (0·64, 0·58–0·70; p=0·01). Interpretation: The PALICC definition identified more children as having PARDS than the Berlin definition, and PALICC PARDS severity groupings improved the stratification of mortality risk, particularly when applied 6 h after PARDS diagnosis. The PALICC PARDS framework should be considered for use in future epidemiological and therapeutic research among children with PARDS. Funding: University of Southern California Clinical Translational Science Institute, Sainte Justine Children's Hospital, University of Montreal, Canada, Réseau en Santé Respiratoire du Fonds de Recherche Quebec-Santé and Children's Hospital Los Angeles, Department of Anesthesiology and Critical Care Medicine.

Original languageEnglish (US)
Pages (from-to)115-128
Number of pages14
JournalThe Lancet Respiratory Medicine
Volume7
Issue number2
DOIs
StatePublished - Feb 1 2019

Fingerprint

Adult Respiratory Distress Syndrome
Observational Studies
Epidemiology
Pediatrics
Incidence
Acute Lung Injury
Pediatric Intensive Care Units
Mortality
Berlin
Area Under Curve

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology (PARDIE) Investigators, & Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network (2019). Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. The Lancet Respiratory Medicine, 7(2), 115-128. https://doi.org/10.1016/S2213-2600(18)30344-8

Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE) : an international, observational study. / Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology (PARDIE) Investigators; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.

In: The Lancet Respiratory Medicine, Vol. 7, No. 2, 01.02.2019, p. 115-128.

Research output: Contribution to journalArticle

Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology (PARDIE) Investigators & Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network 2019, 'Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study', The Lancet Respiratory Medicine, vol. 7, no. 2, pp. 115-128. https://doi.org/10.1016/S2213-2600(18)30344-8
Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology (PARDIE) Investigators, Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. The Lancet Respiratory Medicine. 2019 Feb 1;7(2):115-128. https://doi.org/10.1016/S2213-2600(18)30344-8
Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology (PARDIE) Investigators ; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. / Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE) : an international, observational study. In: The Lancet Respiratory Medicine. 2019 ; Vol. 7, No. 2. pp. 115-128.
@article{01a76cfea7cc4e90afc5cac0d2a9ca8e,
title = "Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study",
abstract = "Background: Paediatric acute respiratory distress syndrome (PARDS) is associated with high mortality in children, but until recently no paediatric-specific diagnostic criteria existed. The Pediatric Acute Lung Injury Consensus Conference (PALICC) definition was developed to overcome limitations of the Berlin definition, which was designed and validated for adults. We aimed to determine the incidence and outcomes of children who meet the PALICC definition of PARDS. Methods: In this international, prospective, cross-sectional, observational study, 145 paediatric intensive care units (PICUs) from 27 countries were recruited, and over a continuous 5 day period across 10 weeks all patients were screened for enrolment. Patients were included if they had a new diagnosis of PARDS that met PALICC criteria during the study week. Exclusion criteria included meeting PARDS criteria more than 24 h before screening, cyanotic heart disease, active perinatal lung disease, and preparation or recovery from a cardiac intervention. Data were collected on the PICU characteristics, patient demographics, and elements of PARDS (ie, PARDS risk factors, hypoxaemia severity metrics, type of ventilation), comorbidities, chest imaging, arterial blood gas measurements, and pulse oximetry. The primary outcome was PICU mortality. Secondary outcomes included 90 day mortality, duration of invasive mechanical and non-invasive ventilation, and cause of death. Findings: Between May 9, 2016, and June 16, 2017, during the 10 study weeks, 23 280 patients were admitted to participating PICUs, of whom 744 (3·2{\%}) were identified as having PARDS. 95{\%} (708 of 744) of patients had complete data for analysis, with 17{\%} (121 of 708; 95{\%} CI 14–20) mortality, whereas only 32{\%} (230 of 708) of patients met Berlin criteria with 27{\%} (61 of 230) mortality. Based on hypoxaemia severity at PARDS diagnosis, mortality was similar among those who were non-invasively ventilated and with mild or moderate PARDS (10–15{\%}), but higher for those with severe PARDS (33{\%} [54 of 165; 95{\%} CI 26–41]). 50{\%} (80 of 160) of non-invasively ventilated patients with PARDS were subsequently intubated, with 25{\%} (20 of 80; 95{\%} CI 16–36) mortality. By use of PALICC PARDS definition, severity of PARDS at 6 h after initial diagnosis (area under the curve [AUC] 0·69, 95{\%} CI 0·62–0·76) discriminates PICU mortality better than severity at PARDS diagnosis (AUC 0·64, 0·58–0·71), and outperforms Berlin severity groups at 6 h (0·64, 0·58–0·70; p=0·01). Interpretation: The PALICC definition identified more children as having PARDS than the Berlin definition, and PALICC PARDS severity groupings improved the stratification of mortality risk, particularly when applied 6 h after PARDS diagnosis. The PALICC PARDS framework should be considered for use in future epidemiological and therapeutic research among children with PARDS. Funding: University of Southern California Clinical Translational Science Institute, Sainte Justine Children's Hospital, University of Montreal, Canada, R{\'e}seau en Sant{\'e} Respiratoire du Fonds de Recherche Quebec-Sant{\'e} and Children's Hospital Los Angeles, Department of Anesthesiology and Critical Care Medicine.",
author = "{Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology (PARDIE) Investigators} and {Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network} and Khemani, {Robinder G.} and Lincoln Smith and Lopez-Fernandez, {Yolanda M.} and Jeni Kwok and Rica Morzov and Klein, {Margaret J.} and Nadir Yehya and Douglas Willson and Kneyber, {Martin C.J.} and Jon Lillie and Analia Fernandez and Newth, {Christopher J.L.} and Philippe Jouvet and Thomas, {Neal J.} and Eugenia Abaleke and Ackerman, {Kate G.} and Carlos Acu{\~n}a and Michelle Adu-Darko and Affolter, {Jeremy T.} and Rachel Agbeko and {Al Amoudi}, Ahmed and Ahmad Alahmadti and Nedaa Aldairi and Omar Alibrahim and Kiona Allen and Christine Allen and Awni Al-Subu and Mar{\'i}a Althabe and Jimena Alvear and Anil, {Ayse Berna} and Heather Anthony and Angela Aramburo and {Arjona Villanueva}, David and Neda Ashtari and {{\'A}vila Vera}, Antonio and Paul Baines and Melissa Bales and Samantha Barr and Dana Barry and Florent Baudin and John Beca and Fernando Beltramo and Laura Benken and Anoopindar Bhalla and Andrea Blom and Priscila Botta and Pierre Bourgoin and Marta Brezmes and George Briassoulis and Asumthia Jeyapalan",
year = "2019",
month = "2",
day = "1",
doi = "10.1016/S2213-2600(18)30344-8",
language = "English (US)",
volume = "7",
pages = "115--128",
journal = "The Lancet Respiratory Medicine",
issn = "2213-2600",
publisher = "Elsevier Limited",
number = "2",

}

TY - JOUR

T1 - Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE)

T2 - an international, observational study

AU - Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology (PARDIE) Investigators

AU - Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

AU - Khemani, Robinder G.

AU - Smith, Lincoln

AU - Lopez-Fernandez, Yolanda M.

AU - Kwok, Jeni

AU - Morzov, Rica

AU - Klein, Margaret J.

AU - Yehya, Nadir

AU - Willson, Douglas

AU - Kneyber, Martin C.J.

AU - Lillie, Jon

AU - Fernandez, Analia

AU - Newth, Christopher J.L.

AU - Jouvet, Philippe

AU - Thomas, Neal J.

AU - Abaleke, Eugenia

AU - Ackerman, Kate G.

AU - Acuña, Carlos

AU - Adu-Darko, Michelle

AU - Affolter, Jeremy T.

AU - Agbeko, Rachel

AU - Al Amoudi, Ahmed

AU - Alahmadti, Ahmad

AU - Aldairi, Nedaa

AU - Alibrahim, Omar

AU - Allen, Kiona

AU - Allen, Christine

AU - Al-Subu, Awni

AU - Althabe, María

AU - Alvear, Jimena

AU - Anil, Ayse Berna

AU - Anthony, Heather

AU - Aramburo, Angela

AU - Arjona Villanueva, David

AU - Ashtari, Neda

AU - Ávila Vera, Antonio

AU - Baines, Paul

AU - Bales, Melissa

AU - Barr, Samantha

AU - Barry, Dana

AU - Baudin, Florent

AU - Beca, John

AU - Beltramo, Fernando

AU - Benken, Laura

AU - Bhalla, Anoopindar

AU - Blom, Andrea

AU - Botta, Priscila

AU - Bourgoin, Pierre

AU - Brezmes, Marta

AU - Briassoulis, George

AU - Jeyapalan, Asumthia

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Background: Paediatric acute respiratory distress syndrome (PARDS) is associated with high mortality in children, but until recently no paediatric-specific diagnostic criteria existed. The Pediatric Acute Lung Injury Consensus Conference (PALICC) definition was developed to overcome limitations of the Berlin definition, which was designed and validated for adults. We aimed to determine the incidence and outcomes of children who meet the PALICC definition of PARDS. Methods: In this international, prospective, cross-sectional, observational study, 145 paediatric intensive care units (PICUs) from 27 countries were recruited, and over a continuous 5 day period across 10 weeks all patients were screened for enrolment. Patients were included if they had a new diagnosis of PARDS that met PALICC criteria during the study week. Exclusion criteria included meeting PARDS criteria more than 24 h before screening, cyanotic heart disease, active perinatal lung disease, and preparation or recovery from a cardiac intervention. Data were collected on the PICU characteristics, patient demographics, and elements of PARDS (ie, PARDS risk factors, hypoxaemia severity metrics, type of ventilation), comorbidities, chest imaging, arterial blood gas measurements, and pulse oximetry. The primary outcome was PICU mortality. Secondary outcomes included 90 day mortality, duration of invasive mechanical and non-invasive ventilation, and cause of death. Findings: Between May 9, 2016, and June 16, 2017, during the 10 study weeks, 23 280 patients were admitted to participating PICUs, of whom 744 (3·2%) were identified as having PARDS. 95% (708 of 744) of patients had complete data for analysis, with 17% (121 of 708; 95% CI 14–20) mortality, whereas only 32% (230 of 708) of patients met Berlin criteria with 27% (61 of 230) mortality. Based on hypoxaemia severity at PARDS diagnosis, mortality was similar among those who were non-invasively ventilated and with mild or moderate PARDS (10–15%), but higher for those with severe PARDS (33% [54 of 165; 95% CI 26–41]). 50% (80 of 160) of non-invasively ventilated patients with PARDS were subsequently intubated, with 25% (20 of 80; 95% CI 16–36) mortality. By use of PALICC PARDS definition, severity of PARDS at 6 h after initial diagnosis (area under the curve [AUC] 0·69, 95% CI 0·62–0·76) discriminates PICU mortality better than severity at PARDS diagnosis (AUC 0·64, 0·58–0·71), and outperforms Berlin severity groups at 6 h (0·64, 0·58–0·70; p=0·01). Interpretation: The PALICC definition identified more children as having PARDS than the Berlin definition, and PALICC PARDS severity groupings improved the stratification of mortality risk, particularly when applied 6 h after PARDS diagnosis. The PALICC PARDS framework should be considered for use in future epidemiological and therapeutic research among children with PARDS. Funding: University of Southern California Clinical Translational Science Institute, Sainte Justine Children's Hospital, University of Montreal, Canada, Réseau en Santé Respiratoire du Fonds de Recherche Quebec-Santé and Children's Hospital Los Angeles, Department of Anesthesiology and Critical Care Medicine.

AB - Background: Paediatric acute respiratory distress syndrome (PARDS) is associated with high mortality in children, but until recently no paediatric-specific diagnostic criteria existed. The Pediatric Acute Lung Injury Consensus Conference (PALICC) definition was developed to overcome limitations of the Berlin definition, which was designed and validated for adults. We aimed to determine the incidence and outcomes of children who meet the PALICC definition of PARDS. Methods: In this international, prospective, cross-sectional, observational study, 145 paediatric intensive care units (PICUs) from 27 countries were recruited, and over a continuous 5 day period across 10 weeks all patients were screened for enrolment. Patients were included if they had a new diagnosis of PARDS that met PALICC criteria during the study week. Exclusion criteria included meeting PARDS criteria more than 24 h before screening, cyanotic heart disease, active perinatal lung disease, and preparation or recovery from a cardiac intervention. Data were collected on the PICU characteristics, patient demographics, and elements of PARDS (ie, PARDS risk factors, hypoxaemia severity metrics, type of ventilation), comorbidities, chest imaging, arterial blood gas measurements, and pulse oximetry. The primary outcome was PICU mortality. Secondary outcomes included 90 day mortality, duration of invasive mechanical and non-invasive ventilation, and cause of death. Findings: Between May 9, 2016, and June 16, 2017, during the 10 study weeks, 23 280 patients were admitted to participating PICUs, of whom 744 (3·2%) were identified as having PARDS. 95% (708 of 744) of patients had complete data for analysis, with 17% (121 of 708; 95% CI 14–20) mortality, whereas only 32% (230 of 708) of patients met Berlin criteria with 27% (61 of 230) mortality. Based on hypoxaemia severity at PARDS diagnosis, mortality was similar among those who were non-invasively ventilated and with mild or moderate PARDS (10–15%), but higher for those with severe PARDS (33% [54 of 165; 95% CI 26–41]). 50% (80 of 160) of non-invasively ventilated patients with PARDS were subsequently intubated, with 25% (20 of 80; 95% CI 16–36) mortality. By use of PALICC PARDS definition, severity of PARDS at 6 h after initial diagnosis (area under the curve [AUC] 0·69, 95% CI 0·62–0·76) discriminates PICU mortality better than severity at PARDS diagnosis (AUC 0·64, 0·58–0·71), and outperforms Berlin severity groups at 6 h (0·64, 0·58–0·70; p=0·01). Interpretation: The PALICC definition identified more children as having PARDS than the Berlin definition, and PALICC PARDS severity groupings improved the stratification of mortality risk, particularly when applied 6 h after PARDS diagnosis. The PALICC PARDS framework should be considered for use in future epidemiological and therapeutic research among children with PARDS. Funding: University of Southern California Clinical Translational Science Institute, Sainte Justine Children's Hospital, University of Montreal, Canada, Réseau en Santé Respiratoire du Fonds de Recherche Quebec-Santé and Children's Hospital Los Angeles, Department of Anesthesiology and Critical Care Medicine.

UR - http://www.scopus.com/inward/record.url?scp=85055089832&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055089832&partnerID=8YFLogxK

U2 - 10.1016/S2213-2600(18)30344-8

DO - 10.1016/S2213-2600(18)30344-8

M3 - Article

C2 - 30361119

AN - SCOPUS:85055089832

VL - 7

SP - 115

EP - 128

JO - The Lancet Respiratory Medicine

JF - The Lancet Respiratory Medicine

SN - 2213-2600

IS - 2

ER -