Parvathaneni Kaushik, Belani Sanjay, Leung Dennis, Newth Christopher J L, Khemani Robinder G
1Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.2Department of Biological Sciences, Dana and David Dornsife College of Letters Arts and Sciences, University of Southern California, Los Angeles, CA.3Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Pediatr Crit Care Med. 2017 Jan;18(1):17-25. doi: 10.1097/PCC.0000000000000945.
The Pediatric Acute Lung Injury Consensus Conference has developed a pediatric-specific definition of acute respiratory distress syndrome, which is a significant departure from both the Berlin and American European Consensus Conference definitions. We sought to test the external validity and potential impact of the Pediatric Acute Lung Injury Consensus Conference definition by comparing the number of cases of acute respiratory distress syndrome and mortality rates among children admitted to a multidisciplinary PICU when classified by Pediatric Acute Lung Injury Consensus Conference, Berlin, and American European Consensus Conference criteria.
Retrospective cohort study.
Tertiary care, university-affiliated PICU.
All patients admitted between March 2009 and April 2013 who met inclusion criteria for acute respiratory distress syndrome.
None.
Of 4,764 patients admitted to the ICU, 278 (5.8%) met Pediatric Acute Lung Injury Consensus Conference pediatric acute respiratory distress syndrome criteria with a mortality rate of 22.7%. One hundred forty-three (32.2% mortality) met Berlin criteria, and 134 (30.6% mortality) met American European Consensus Conference criteria. All patients who met American European Consensus Conference criteria and 141 (98.6%) patients who met Berlin criteria also met Pediatric Acute Lung Injury Consensus Conference criteria. The 137 patients who met Pediatric Acute Lung Injury Consensus Conference but not Berlin criteria had an overall mortality rate of 13.1%, but 29 had severe acute respiratory distress syndrome with 31.0% mortality. At acute respiratory distress syndrome onset, there was minimal difference in mortality between mild or moderate acute respiratory distress syndrome by both Berlin (32.4% vs 25.0%, respectively) and Pediatric Acute Lung Injury Consensus Conference (16.7% vs 18.6%, respectively) criteria, but higher mortality for severe acute respiratory distress syndrome (Berlin, 43.6%; Pediatric Acute Lung Injury Consensus Conference, 37.0%). Twenty-four hours after acute respiratory distress syndrome onset, the presence of severe acute respiratory distress syndrome (using either Berlin or Pediatric Acute Lung Injury Consensus Conference) was associated with nearly 50% mortality.
Applying the Pediatric Acute Lung Injury Consensus Conference definition of acute respiratory distress syndrome has the potential to significantly increase the number of acute respiratory distress syndrome patients identified, with a lower overall mortality rate. However, severe acute respiratory distress syndrome is associated with extremely high mortality, particularly if present at 24 hours after initial diagnosis.
儿科急性肺损伤共识会议制定了针对儿科的急性呼吸窘迫综合征定义，这与柏林定义和欧美共识会议定义均有显著差异。我们试图通过比较按照儿科急性肺损伤共识会议、柏林和欧美共识会议标准分类时，多学科儿科重症监护病房（PICU）收治儿童中急性呼吸窘迫综合征的病例数和死亡率，来检验儿科急性肺损伤共识会议定义的外部有效性和潜在影响。
回顾性队列研究。
三级医疗、大学附属医院的PICU。
2009年3月至2013年4月期间收治的所有符合急性呼吸窘迫综合征纳入标准的患者。
无。
在4764例入住ICU的患者中，278例（5.8%）符合儿科急性肺损伤共识会议的儿科急性呼吸窘迫综合征标准，死亡率为22.7%。143例（死亡率32.2%）符合柏林标准，134例（死亡率30.6%）符合欧美共识会议标准。所有符合欧美共识会议标准的患者以及141例（98.6%）符合柏林标准的患者也符合儿科急性肺损伤共识会议标准。137例符合儿科急性肺损伤共识会议标准但不符合柏林标准的患者总体死亡率为13.1%，但其中29例患有重度急性呼吸窘迫综合征，死亡率为31.0%。在急性呼吸窘迫综合征发病时，按照柏林标准（分别为32.4%和25.0%）和儿科急性肺损伤共识会议标准（分别为16.7%和18.6%），轻度或中度急性呼吸窘迫综合征的死亡率差异最小，但重度急性呼吸窘迫综合征的死亡率更高（柏林标准为43.6%；儿科急性肺损伤共识会议标准为37.0%）。急性呼吸窘迫综合征发病24小时后，重度急性呼吸窘迫综合征（使用柏林标准或儿科急性肺损伤共识会议标准）的存在与近50%的死亡率相关。
应用儿科急性肺损伤共识会议的急性呼吸窘迫综合征定义有可能显著增加确诊的急性呼吸窘迫综合征患者数量，且总体死亡率较低。然而，重度急性呼吸窘迫综合征的死亡率极高，尤其是在初始诊断后24小时出现时。
