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Review
. 2023 Feb 1;24(12 Suppl 2):S12-S27.
doi: 10.1097/PCC.0000000000003156. Epub 2023 Jan 20.

Pathobiology, Severity, and Risk Stratification of Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

Jocelyn R Grunwell  1   2 , Mary K Dahmer  3 , Anil Sapru  4 , Michael W Quasney  3 , Heidi Flori  3 ; Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) for the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Collaborators, Affiliations
Review

Pathobiology, Severity, and Risk Stratification of Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

Jocelyn R Grunwell et al. Pediatr Crit Care Med. .

Abstract

Objectives: To review the literature for studies published in children on the pathobiology, severity, and risk stratification of pediatric acute respiratory distress syndrome (PARDS) with the intent of guiding current medical practice and identifying important areas for future research related to severity and risk stratification.

Data sources: Electronic searches of PubMed and Embase were conducted from 2013 to March 2022 by using a combination of medical subject heading terms and text words to capture the pathobiology, severity, and comorbidities of PARDS.

Study selection: We included studies of critically ill patients with PARDS that related to the severity and risk stratification of PARDS using characteristics other than the oxygenation defect. Studies using animal models, adult only, and studies with 10 or fewer children were excluded from our review.

Data extraction: Title/abstract review, full-text review, and data extraction using a standardized data collection form.

Data synthesis: The Grading of Recommendations Assessment, Development, and Evaluation approach was used to identify and summarize relevant evidence and develop recommendations for clinical practice. There were 192 studies identified for full-text extraction to address the relevant Patient/Intervention/Comparator/Outcome questions. One clinical recommendation was generated related to the use of dead space fraction for risk stratification. In addition, six research statements were generated about the impact of age on acute respiratory distress syndrome pathobiology and outcomes, addressing PARDS heterogeneity using biomarkers to identify subphenotypes and endotypes, and use of standardized ventilator, physiologic, and nonpulmonary organ failure measurements for future research.

Conclusions: Based on an extensive literature review, we propose clinical management and research recommendations related to characterization and risk stratification of PARDS severity.

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Conflict of interest statement

Drs. Grunwell, Sapru, and Flori received support for article research from the National Institutes of Health (NIH). Dr. Dahmer’s institution received funding from the National Institute for Child Health and Human Development and the National Heart, Lung, and Blood Institute. Drs. Sapru’s and Flori’s institutions received funding from the NIH. Dr. Flori’s institution received funding from the Society of Critical Care Medicine; she received funding from Lucira Health. Dr. Quasney has disclosed that he does not have any potential conflicts of interest.

References

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