Outcomes of Children Surviving Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

Abstract

Objectives: To summarize the evidence for the Second Pediatric Acute Lung Injury Consensus Conference-2 (PALICC-2) recommendations for assessment of outcomes among patients surviving pediatric acute respiratory distress syndrome (PARDS).

Data sources: MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost).

Study selection: We conducted a scoping review to identify studies evaluating outcomes following PARDS. We included studies of survivors of PARDS, acute respiratory failure with a high proportion of PARDS patients, or other critical illnesses if PARDS-specific outcomes could be extracted.

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 evidence and develop recommendations. Of 8,037 abstracts screened, we identified 20 articles for inclusion. Morbidity following PARDS was common and affected multiple domains of pulmonary and nonpulmonary function. There was insufficient evidence to generate any evidence-based recommendations. We generated eight good practice statements and five research statements. A panel of 52 experts discussed each proposed good practice statement and research statement, and the agreement rate was measured with an online voting process. Good practice statements describe the approach to clinical outcome assessment, assessment of pulmonary outcomes of children surviving PARDS, and assessment of nonpulmonary outcomes of children surviving PARDS including health-related quality of life and physical, neurocognitive, emotional, family, and social functioning. The five research statements relate to assessment of patient preillness status, use of postdischarge endpoints for clinical trials, the association between short-term and longer term outcomes, the trajectory of recovery following PARDS, and practices to optimize follow-up.

Conclusions: There is increasing evidence that children are at risk for impairments across a range of pulmonary and nonpulmonary health domains following hospitalization for PARDS. The results of this extensive scoping review and consensus conference involving experts in PARDS research, clinical care, and outcomes assessment provide guidance to clinicians and researchers on postdischarge follow-up to optimize the long-term health of patients surviving PARDS.

Figure 1.

Proportion of patients with impairments in pulmonary outcomes based on time of assessment and domain. Studies listed by population evaluated and reference number. ARDS, acute respiratory distress syndrome.

Figure 2.

Proportion of patients with impairments in non-pulmonary outcomes based on time of assessment and domain. Studies listed by population evaluated and reference number. ARDS, acute respiratory distress syndrome; ARF, acute respiratory failure; HRQL, health-related quality of life; Immuno, immunocompromised; NMB, neuromuscular blockade; PTSD, post-traumatic stress disorder. *Assessed neuropathy/myopathy.

Figure 3.

Proportion of patients with post-discharge mortality based on time of assessment. Studies listed by population evaluated and reference number. ARDS, acute respiratory distress syndrome; ECMO, extracorporeal membrane oxygenation; Immuno, immunocompromised.