The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood: multicenter evaluation and expert consensus
Identifieur interne : 001816 ( Istex/Curation ); précédent : 001815; suivant : 001817The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood: multicenter evaluation and expert consensus
Auteurs : Daniele De Luca [Italie, France] ; Marco Piastra [Italie] ; Giovanna Chidini [Italie] ; Pierre Tissieres [France] ; Edoardo Calderini [Italie] ; Sandrine Essouri [France] ; Alberto Medina Villanueva [Espagne] ; Ana Vivanco Allende [Espagne] ; Marti Pons-Odena [Espagne] ; Luis Perez-Baena [Espagne] ; Michael Hermon [Autriche] ; Ascanio Tridente [Royaume-Uni] ; Giorgio Conti [Italie] ; Massimo Antonelli [Italie] ; Martin Kneyber [Pays-Bas]Source :
- Intensive Care Medicine [ 0342-4642 ] ; 2013.
Abstract
Abstract: Purpose: A new acute respiratory distress syndrome (ARDS) definition has been recently issued: the so-called Berlin definition (BD) has some characteristics that could make it suitable for pediatrics. The European Society for Pediatric Neonatal Intensive Care (ESPNIC) Respiratory Section started a project to evaluate BD validity in early childhood. A secondary aim was reaching a consensus on clinical tools (risk factors list and illustrative radiographs) to help the application of BD. Methods: This was an international, multicenter, retrospective study enrolling 221 children [aged greater than 30 days and less than 18 months; median age 6 (range 2–13) months], admitted to seven European pediatric intensive care units (PICU) with acute lung injury (ALI) or ARDS diagnosed with the earlier definition. Results: Patients were categorized according to the two definitions, as follows: ALI, 36; ARDS, 185 (for the American–European Consensus Conference (AECC) definition); mild, 36; moderate, 97; severe ARDS, 88 (for BD). Mortality (13.9 % for mild ARDS; 11.3 % for moderate ARDS; 25 % for severe ARDS, p = 0.04) and the composite outcome extracorporeal membrane oxygenation (ECMO)/mortality (13.9 % for mild ARDS; 11.3 % for moderate ARDS; 28.4 % for severe ARDS, p < 0.01) were different across the BD classes, whereas they were similar using the previous definition. Mortality [HR 2.7 (95 % CI 1.1–7.1)] and ECMO/mortality [HR 3 (95 % CI 1.1–7.9)] were increased only for the severe ARDS class and remained significant after adjustment for confounding factors. PICU stay was not different across severity classes, irrespective of the definition used. There was significant concordance between raters evaluating radiographs [ICC 0.6 (95 % CI 0.2–0.8)] and risk factors [ICC 0.92 (95 % CI 0.8–0.97)]. Conclusions: BD validity for children is similar to that already reported in adults and mainly due to the introduction of a “severe ARDS” category. We provided clinical tools to use BD for clinical practice, research, and health services planning in pediatric critical care.
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DOI: 10.1007/s00134-013-3110-x
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Rome</wicri:regionArea></affiliation></author><author><name sortKey="Chidini, Giovanna" sort="Chidini, Giovanna" uniqKey="Chidini G" first="Giovanna" last="Chidini">Giovanna Chidini</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Tissieres, Pierre" sort="Tissieres, Pierre" uniqKey="Tissieres P" first="Pierre" last="Tissieres">Pierre Tissieres</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, CHU Kremlin-Bicetre, South Paris University Teaching Hospitals, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Pediatric Intensive Care Unit, CHU Kremlin-Bicetre, South Paris University Teaching Hospitals, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Calderini, Edoardo" sort="Calderini, Edoardo" uniqKey="Calderini E" first="Edoardo" last="Calderini">Edoardo Calderini</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Essouri, Sandrine" sort="Essouri, Sandrine" uniqKey="Essouri S" first="Sandrine" last="Essouri">Sandrine Essouri</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, CHU Kremlin-Bicetre, South Paris University Teaching Hospitals, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Pediatric Intensive Care Unit, CHU Kremlin-Bicetre, South Paris University Teaching Hospitals, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Medina Villanueva, Alberto" sort="Medina Villanueva, Alberto" uniqKey="Medina Villanueva A" first="Alberto" last="Medina Villanueva">Alberto Medina Villanueva</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario de Asturias, Oviedo, Spain</mods:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario de Asturias, Oviedo</wicri:regionArea></affiliation></author><author><name sortKey="Vivanco Allende, Ana" sort="Vivanco Allende, Ana" uniqKey="Vivanco Allende A" first="Ana" last="Vivanco Allende">Ana Vivanco Allende</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario de Asturias, Oviedo, Spain</mods:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario de Asturias, Oviedo</wicri:regionArea></affiliation></author><author><name sortKey="Pons Odena, Marti" sort="Pons Odena, Marti" uniqKey="Pons Odena M" first="Marti" last="Pons-Odena">Marti Pons-Odena</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care and Intermediate Care Unit, Department of Pediatrics, Hospital Universitari Sant Joan de Déu, Barcelona, Spain</mods:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Pediatric Intensive Care and Intermediate Care Unit, Department of Pediatrics, Hospital Universitari Sant Joan de Déu, Barcelona</wicri:regionArea></affiliation></author><author><name sortKey="Perez Baena, Luis" sort="Perez Baena, Luis" uniqKey="Perez Baena L" first="Luis" last="Perez-Baena">Luis Perez-Baena</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care and Intermediate Care Unit, Department of Pediatrics, Hospital Universitari Sant Joan de Déu, Barcelona, Spain</mods:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Pediatric Intensive Care and Intermediate Care Unit, Department of Pediatrics, Hospital Universitari Sant Joan de Déu, Barcelona</wicri:regionArea></affiliation></author><author><name sortKey="Hermon, Michael" sort="Hermon, Michael" uniqKey="Hermon M" first="Michael" last="Hermon">Michael Hermon</name><affiliation wicri:level="1"><mods:affiliation>Division of Neonatology, Intensive Care and Neuro-pediatrics, Medical University of Vienna, Vienna, Austria</mods:affiliation><country xml:lang="fr">Autriche</country><wicri:regionArea>Division of Neonatology, Intensive Care and Neuro-pediatrics, Medical University of Vienna, Vienna</wicri:regionArea></affiliation></author><author><name sortKey="Tridente, Ascanio" sort="Tridente, Ascanio" uniqKey="Tridente A" first="Ascanio" last="Tridente">Ascanio Tridente</name><affiliation wicri:level="1"><mods:affiliation>Intensive Care Unit, Whiston Hospital, St. Helen’s and Knowsley Teaching Hospitals NHS Trust, UK and academic Unit of Medical Education, Sheffield Medical School, University of Sheffield, Sheffield, UK</mods:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Intensive Care Unit, Whiston Hospital, St. Helen’s and Knowsley Teaching Hospitals NHS Trust, UK and academic Unit of Medical Education, Sheffield Medical School, University of Sheffield, Sheffield</wicri:regionArea></affiliation></author><author><name sortKey="Conti, Giorgio" sort="Conti, Giorgio" uniqKey="Conti G" first="Giorgio" last="Conti">Giorgio Conti</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart, Rome, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart, Rome</wicri:regionArea></affiliation></author><author><name sortKey="Antonelli, Massimo" sort="Antonelli, Massimo" uniqKey="Antonelli M" first="Massimo" last="Antonelli">Massimo Antonelli</name><affiliation wicri:level="1"><mods:affiliation>General Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart, Rome, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>General Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart, Rome</wicri:regionArea></affiliation></author><author><name sortKey="Kneyber, Martin" sort="Kneyber, Martin" uniqKey="Kneyber M" first="Martin" last="Kneyber">Martin Kneyber</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands</mods:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Pediatric Intensive Care Unit, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:0879E74D661E8A1B93A6DEB58D4004188719E455</idno><date when="2013" year="2013">2013</date><idno type="doi">10.1007/s00134-013-3110-x</idno><idno type="url">https://api.istex.fr/ark:/67375/VQC-6M0WKS1C-V/fulltext.pdf</idno><idno type="wicri:Area/Istex/Corpus">001816</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">001816</idno><idno type="wicri:Area/Istex/Curation">001816</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood: multicenter evaluation and expert consensus</title><author><name sortKey="De Luca, Daniele" sort="De Luca, Daniele" uniqKey="De Luca D" first="Daniele" last="De Luca">Daniele De Luca</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart, Rome, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart, Rome</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>Neonatal Intensive Care Unit, CHU Antoine Béclère, South Paris University Teaching Hospitals, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Neonatal Intensive Care Unit, CHU Antoine Béclère, South Paris University Teaching Hospitals, Paris</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>Terapia Intensiva Pediatrica–DEA, Policlinico Universitario “A. Gemelli”–Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Terapia Intensiva Pediatrica–DEA, Policlinico Universitario “A. Gemelli”–Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>E-mail: daniele.deluca@rm.unicatt.it</mods:affiliation><country wicri:rule="url">Italie</country></affiliation><affiliation wicri:level="1"><mods:affiliation>E-mail: dm.deluca@fastwebnet.it</mods:affiliation><country wicri:rule="url">Italie</country></affiliation></author><author><name sortKey="Piastra, Marco" sort="Piastra, Marco" uniqKey="Piastra M" first="Marco" last="Piastra">Marco Piastra</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart, Rome, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart, Rome</wicri:regionArea></affiliation></author><author><name sortKey="Chidini, Giovanna" sort="Chidini, Giovanna" uniqKey="Chidini G" first="Giovanna" last="Chidini">Giovanna Chidini</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Tissieres, Pierre" sort="Tissieres, Pierre" uniqKey="Tissieres P" first="Pierre" last="Tissieres">Pierre Tissieres</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, CHU Kremlin-Bicetre, South Paris University Teaching Hospitals, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Pediatric Intensive Care Unit, CHU Kremlin-Bicetre, South Paris University Teaching Hospitals, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Calderini, Edoardo" sort="Calderini, Edoardo" uniqKey="Calderini E" first="Edoardo" last="Calderini">Edoardo Calderini</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Essouri, Sandrine" sort="Essouri, Sandrine" uniqKey="Essouri S" first="Sandrine" last="Essouri">Sandrine Essouri</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, CHU Kremlin-Bicetre, South Paris University Teaching Hospitals, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Pediatric Intensive Care Unit, CHU Kremlin-Bicetre, South Paris University Teaching Hospitals, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Medina Villanueva, Alberto" sort="Medina Villanueva, Alberto" uniqKey="Medina Villanueva A" first="Alberto" last="Medina Villanueva">Alberto Medina Villanueva</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario de Asturias, Oviedo, Spain</mods:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario de Asturias, Oviedo</wicri:regionArea></affiliation></author><author><name sortKey="Vivanco Allende, Ana" sort="Vivanco Allende, Ana" uniqKey="Vivanco Allende A" first="Ana" last="Vivanco Allende">Ana Vivanco Allende</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario de Asturias, Oviedo, Spain</mods:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario de Asturias, Oviedo</wicri:regionArea></affiliation></author><author><name sortKey="Pons Odena, Marti" sort="Pons Odena, Marti" uniqKey="Pons Odena M" first="Marti" last="Pons-Odena">Marti Pons-Odena</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care and Intermediate Care Unit, Department of Pediatrics, Hospital Universitari Sant Joan de Déu, Barcelona, Spain</mods:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Pediatric Intensive Care and Intermediate Care Unit, Department of Pediatrics, Hospital Universitari Sant Joan de Déu, Barcelona</wicri:regionArea></affiliation></author><author><name sortKey="Perez Baena, Luis" sort="Perez Baena, Luis" uniqKey="Perez Baena L" first="Luis" last="Perez-Baena">Luis Perez-Baena</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care and Intermediate Care Unit, Department of Pediatrics, Hospital Universitari Sant Joan de Déu, Barcelona, Spain</mods:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Pediatric Intensive Care and Intermediate Care Unit, Department of Pediatrics, Hospital Universitari Sant Joan de Déu, Barcelona</wicri:regionArea></affiliation></author><author><name sortKey="Hermon, Michael" sort="Hermon, Michael" uniqKey="Hermon M" first="Michael" last="Hermon">Michael Hermon</name><affiliation wicri:level="1"><mods:affiliation>Division of Neonatology, Intensive Care and Neuro-pediatrics, Medical University of Vienna, Vienna, Austria</mods:affiliation><country xml:lang="fr">Autriche</country><wicri:regionArea>Division of Neonatology, Intensive Care and Neuro-pediatrics, Medical University of Vienna, Vienna</wicri:regionArea></affiliation></author><author><name sortKey="Tridente, Ascanio" sort="Tridente, Ascanio" uniqKey="Tridente A" first="Ascanio" last="Tridente">Ascanio Tridente</name><affiliation wicri:level="1"><mods:affiliation>Intensive Care Unit, Whiston Hospital, St. Helen’s and Knowsley Teaching Hospitals NHS Trust, UK and academic Unit of Medical Education, Sheffield Medical School, University of Sheffield, Sheffield, UK</mods:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Intensive Care Unit, Whiston Hospital, St. Helen’s and Knowsley Teaching Hospitals NHS Trust, UK and academic Unit of Medical Education, Sheffield Medical School, University of Sheffield, Sheffield</wicri:regionArea></affiliation></author><author><name sortKey="Conti, Giorgio" sort="Conti, Giorgio" uniqKey="Conti G" first="Giorgio" last="Conti">Giorgio Conti</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart, Rome, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart, Rome</wicri:regionArea></affiliation></author><author><name sortKey="Antonelli, Massimo" sort="Antonelli, Massimo" uniqKey="Antonelli M" first="Massimo" last="Antonelli">Massimo Antonelli</name><affiliation wicri:level="1"><mods:affiliation>General Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart, Rome, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>General Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart, Rome</wicri:regionArea></affiliation></author><author><name sortKey="Kneyber, Martin" sort="Kneyber, Martin" uniqKey="Kneyber M" first="Martin" last="Kneyber">Martin Kneyber</name><affiliation wicri:level="1"><mods:affiliation>Pediatric Intensive Care Unit, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands</mods:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Pediatric Intensive Care Unit, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen</wicri:regionArea></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Intensive Care Medicine</title><title level="j" type="abbrev">Intensive Care Med</title><idno type="ISSN">0342-4642</idno><idno type="eISSN">1432-1238</idno><imprint><publisher ref="https://scientific-publisher.data.istex.fr/ark:/67375/H02-SWLMH5L1-1">Springer Berlin Heidelberg</publisher><pubPlace>Berlin/Heidelberg</pubPlace><date type="published" when="2013">2013</date><biblScope unit="vol" from="39" to="39">39</biblScope><biblScope unit="issue" from="12" to="12">12</biblScope><biblScope unit="page" from="2083">2083</biblScope><biblScope unit="page" to="2091">2091</biblScope></imprint><idno type="ISSN">0342-4642</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0342-4642</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Abstract: Purpose: A new acute respiratory distress syndrome (ARDS) definition has been recently issued: the so-called Berlin definition (BD) has some characteristics that could make it suitable for pediatrics. The European Society for Pediatric Neonatal Intensive Care (ESPNIC) Respiratory Section started a project to evaluate BD validity in early childhood. A secondary aim was reaching a consensus on clinical tools (risk factors list and illustrative radiographs) to help the application of BD. Methods: This was an international, multicenter, retrospective study enrolling 221 children [aged greater than 30 days and less than 18 months; median age 6 (range 2–13) months], admitted to seven European pediatric intensive care units (PICU) with acute lung injury (ALI) or ARDS diagnosed with the earlier definition. Results: Patients were categorized according to the two definitions, as follows: ALI, 36; ARDS, 185 (for the American–European Consensus Conference (AECC) definition); mild, 36; moderate, 97; severe ARDS, 88 (for BD). Mortality (13.9 % for mild ARDS; 11.3 % for moderate ARDS; 25 % for severe ARDS, p = 0.04) and the composite outcome extracorporeal membrane oxygenation (ECMO)/mortality (13.9 % for mild ARDS; 11.3 % for moderate ARDS; 28.4 % for severe ARDS, p < 0.01) were different across the BD classes, whereas they were similar using the previous definition. Mortality [HR 2.7 (95 % CI 1.1–7.1)] and ECMO/mortality [HR 3 (95 % CI 1.1–7.9)] were increased only for the severe ARDS class and remained significant after adjustment for confounding factors. PICU stay was not different across severity classes, irrespective of the definition used. There was significant concordance between raters evaluating radiographs [ICC 0.6 (95 % CI 0.2–0.8)] and risk factors [ICC 0.92 (95 % CI 0.8–0.97)]. Conclusions: BD validity for children is similar to that already reported in adults and mainly due to the introduction of a “severe ARDS” category. We provided clinical tools to use BD for clinical practice, research, and health services planning in pediatric critical care.</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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|texte= The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood: multicenter evaluation and expert consensus
}}
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