Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Mar;169(3-4):93-98.
doi: 10.1007/s10354-018-0659-6. Epub 2018 Sep 19.

Extended use of the modified Berlin Definition based on age-related subgroup analysis in pediatric ARDS

Michael Hermon  1 , Sophia Dotzler  2 , Jennifer Bettina Brandt  3 , Wolfgang Strohmaier  4 , Johann Golej  3
Affiliations

Extended use of the modified Berlin Definition based on age-related subgroup analysis in pediatric ARDS

Michael Hermon et al. Wien Med Wochenschr. 2019 Mar.

Abstract

Background: Pediatric acute respiratory distress syndrome (pARDS) is a rare but very severe condition. Management of the condition remains a major challenge for pediatric intensive care specialists.

Objective: To perform a descriptive assessment of pARDS based on the modified Berlin Definition by using the SpO2/FiO2 ratio in order to establish an extended patient registry divided into age-related subgroups.

Methods: The data of all children on mechanical ventilation for respiratory failure admitted between 2005 and 2012 were reviewed retrospectively for this study. The age of patients ranged from newborns >37 weeks, up to children <18 years. Inclusion criteria were based on the modified Berlin Definition of pARDS. The following data were collected: demographic data, primary diagnosis, ventilation settings, and use of supportive treatment, in addition to mechanical ventilation (inhaled nitric oxide, surfactant, corticosteroids, prone positioning, and extracorporeal membrane oxygenation).

Results: In all, 93 children where included: 35% were newborns, 29% infants, 24% toddlers, and 12% school children; 66% were male and 34% were female patients. The most common primary diagnosis was viral pneumonia (21%) and 55% of the children were diagnosed with severe ARDS. The median duration of stay on the pediatric intensive care unit was 16 days (10/27). In total, 66 children (71%) had direct lung injury and 18 (19%) had indirect lung injury. More than 80% of all children needed more than one supportive care therapy. The overall survival rate was 77%.

Conclusion: This study is a valuable report about pediatric patients with ARDS and allows for an important extension of the application of the modified Berlin Definition in all age groups.

Keywords: ARDS supportive treatment; Berlin Definition; Children; Pediatric ARDS; SpO2/FiO2 ratio.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest

M. Hermon, S. Dotzler, J.B. Brandt, W. Strohmaier, and J. Golej declare that they have no competing interests and financial potential conflicts do not exist.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments, or comparable ethical standards. For this type of study (retrospective study) informed consent is not required. This study was done with the approval of the of the ethics committee (Medical University of Vienna; Ethic Nr.-1860/2012).

Figures

Fig. 1
Fig. 1
Severity of pediatric acute respiratory distress syndrome (pARDS). According to the modified Berlin Definition, most of the patients had severe pARDS on the day of admission
Fig. 2
Fig. 2
Supportive care treatment separated into age-related subgroups. The figure shows the distribution of treatment strategies between the four age subgroups. The distribution refers to the total number of the supportive therapies that were used and not to the number of patients. ECMO extracorporeal membrane oxygenation, iNO inhaled nitric oxide
See this image and copyright information in PMC

References

    1. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967;2(7511):319–323. doi: 10.1016/S0140-6736(67)90168-7. - DOI - PubMed
    1. Zimmerman JJ, Akhtar SR, Caldwell E, Rubenfeld GD. Incidence and outcomes of pediatric acute lung injury. Pediatrics. 2009;124(1):87–95. doi: 10.1542/peds.2007-2462. - DOI - PubMed
    1. Kneyber MCJ, Brouwers AGA, Caris JA, Chedamni S, Plötz FB. Acute respiratory distress syndrome: is it underrecognized in the pediatric intensive care unit? intensive Care Med. 2008;34(4):751–754. doi: 10.1007/s00134-008-1029-4. - DOI - PMC - PubMed
    1. Wong JJ-M, Jit M, Sultana R, et al. Mortality in pediatric acute respiratory distress syndrome: a systematic review and Meta-analysis. J Intensive Care Med. 2017 doi: 10.1177/0885066617705109. - DOI - PubMed
    1. Bernard GR, Artigas A, Brigham KL, The American-European Consensus Conference on ARDS et al. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149(3 Pt 1):818–824. doi: 10.1164/ajrccm.149.3.7509706. - DOI - PubMed

LinkOut - more resources