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

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 SpO(2)/FiO(2) 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.