Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2)

Author:

Emeriaud Guillaume1,López-Fernández Yolanda M.2,Iyer Narayan Prabhu3,Bembea Melania M.4,Agulnik Asya5,Barbaro Ryan P.6,Baudin Florent7,Bhalla Anoopindar8,Brunow de Carvalho Werther9,Carroll Christopher L.10,Cheifetz Ira M.11,Chisti Mohammod J.12,Cruces Pablo1314,Curley Martha A. Q.1516,Dahmer Mary K.6,Dalton Heidi J.17,Erickson Simon J.18,Essouri Sandrine1,Fernández Analía19,Flori Heidi R.6,Grunwell Jocelyn R.20,Jouvet Philippe1,Killien Elizabeth Y.21,Kneyber Martin C. J.22,Kudchadkar Sapna R.423,Korang Steven Kwasi824,Lee Jan Hau25,Macrae Duncan J.26,Maddux Aline27,Modesto i Alapont Vicent28,Morrow Brenda M.29,Nadkarni Vinay M.30,Napolitano Natalie31,Newth Christopher J. L.8,Pons-Odena Martí32,Quasney Michael W.6,Rajapreyar Prakadeshwari33,Rambaud Jerome34,Randolph Adrienne G.35,Rimensberger Peter36,Rowan Courtney M.37,Sanchez-Pinto L. Nelson38,Sapru Anil39,Sauthier Michael1,Shein Steve L.11,Smith Lincoln S.40,Steffen Katerine41,Takeuchi Muneyuki42,Thomas Neal J.43,Tse Sze Man1,Valentine Stacey44,Ward Shan45,Watson R. Scott2146,Yehya Nadir30,Zimmerman Jerry J.4047,Khemani Robinder G.8,

Affiliation:

1. Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada.

2. Pediatric Intensive Care Unit, Department of Pediatrics, Cruces University Hospital, Biocruces-Bizkaia Health Research Institute, Bizkaia, Spain.

3. Fetal and Neonatal Institute, Division of Neonatology, Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.

4. Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

5. Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN.

6. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI.

7. Pediatric Intensive Care Unit, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Réanimation Pédiatrique, Lyon, France.

8. Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles. Keck School of Medicine, University of Southern California, Los Angeles, CA.

9. Department of Pediatrics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.

10. Department of Pediatrics, Connecticut Children´s, Hartford, CT.

11. Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH.

12. Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh.

13. Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile.

14. Departamento de Pediatría, Unidad de Paciente Crítico Pediátrico, Facultad de Ciencias de la Vida, Hospital El Carmen de Maipú, Santiago, Chile.

15. Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA.

16. Research Institute, Children’s Hospital of Philadelphia, Philadelphia, PA.

17. Department of Pediatrics and Heart and Vascular Institute, INOVA Fairfax Medical Center, Falls Church, VA.

18. Department of Paediatric Critical Care, Perth Children’s Hospital Western Australia, Perth, WA, Australia.

19. Pediatric Intensive Care Unit, Emergency Department, Hospital General de Agudos “C. Durand” Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.

20. Division of Critical Care, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.

21. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.

22. Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

23. Departments of Pediatrics, Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.

24. Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

25. KK Women’s and Children’s Hospital, Singapore and Duke-NUS Medical School, Singapore.

26. Cardiac Critical Care and ECMO, Sidra Medicine, Doha, Qatar.

27. Department of Pediatrics, Section of Pediatric Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO.

28. Pediatric Intensive Care Unit, Hospital Universitari I Politècnic La Fe, València, Spain.

29. Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.

30. Department of Anesthesiology, Critical Care and Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

31. Respiratory Therapy Department, Children’s Hospital of Philadelphia, Philadelphia, PA.

32. Immunological and Respiratory Disorders, Paediatric Critical Care Unit Research Group, Institut de Recerca Sant Joan de Déu, Pediatric Intensive Care and Intermediate Care Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.

33. Department of Pediatrics, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee, WI.

34. Departement of Pediatric and Neonatal Intensive Care, Armand-Trousseau Hospital, Sorbonne University, Paris, France.

35. Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, and Departments of Anaesthesia and Pediatrics, Harvard Medical School, Boston, MA.

36. Division of Neonatology and Paediatric Intensive Care, University of Geneva, Geneva, Switzerland.

37. Department of Pediatrics, Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN.

38. Departments of Pediatrics (Critical Care) and Preventive Medicine (Health & Biomedical Informatics), Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL.

39. Division of Pediatric Critical Care, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA.

40. Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle, WA.

41. Department of Pediatrics, Division of Pediatric Critical Care, Stanford University, Palo Alto, CA.

42. Department of Intensive Care Medicine, Osaka Women’s and Children’s Hospital, Osaka, Japan.

43. Division of Pediatric Critical Care Medicine, Department of Pediatrics and Public Health Sciences, Penn State University College of Medicine, Hershey, PA.

44. Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA.

45. Department of Pediatrics, University of California San Francisco, Benioff Children’s Hospitals, San Francisco and Oakland, CA.

46. Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute Seattle, WA.

47. Harborview Medical Center, University of Washington School of Medicine, Seattle, WA.

Abstract

OBJECTIVES: We sought to update our 2015 work in the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PARDS), considering new evidence and topic areas that were not previously addressed. DESIGN: International consensus conference series involving 52 multidisciplinary international content experts in PARDS and four methodology experts from 15 countries, using consensus conference methodology, and implementation science. SETTING: Not applicable. PATIENTS: Patients with or at risk for PARDS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Eleven subgroups conducted systematic or scoping reviews addressing 11 topic areas: 1) definition, incidence, and epidemiology; 2) pathobiology, severity, and risk stratification; 3) ventilatory support; 4) pulmonary-specific ancillary treatment; 5) nonpulmonary treatment; 6) monitoring; 7) noninvasive respiratory support; 8) extracorporeal support; 9) morbidity and long-term outcomes; 10) clinical informatics and data science; and 11) resource-limited settings. The search included MEDLINE, EMBASE, and CINAHL Complete (EBSCOhost) and was updated in March 2022. Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to summarize evidence and develop the recommendations, which were discussed and voted on by all PALICC-2 experts. There were 146 recommendations and statements, including: 34 recommendations for clinical practice; 112 consensus-based statements with 18 on PARDS definition, 55 on good practice, seven on policy, and 32 on research. All recommendations and statements had agreement greater than 80%. CONCLUSIONS: PALICC-2 recommendations and consensus-based statements should facilitate the implementation and adherence to the best clinical practice in patients with PARDS. These results will also inform the development of future programs of research that are crucially needed to provide stronger evidence to guide the pediatric critical care teams managing these patients.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Critical Care and Intensive Care Medicine,Pediatrics, Perinatology and Child Health

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