Evaluating the Performance of the Pediatric Acute Lung Injury Consensus Conference Definition of Acute Respiratory Distress Syndrome
Evaluating the Performance of the Pediatric Acute Lung Injury Consensus Conference Definition of Acute Respiratory Distress Syndrome
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评估儿科急性肺损伤共识会议对急性呼吸窘迫综合征定义的应用表现
DOI：
10.1097/pcc.0000000000000945
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发表时间：
2017-01-01
影响因子：
4.1
通讯作者：
Khemani, Robinder G.
中科院分区：
文献类型：
--
作者：
Parvathaneni, Kaushik;Belani, Sanjay;Khemani, Robinder G.
目的：儿科急性肺损伤共识会议制定了针对儿科的急性呼吸窘迫综合征的定义，这与柏林和美国欧洲共识会议的定义有很大的不同。我们试图测试儿科急性肺损伤共识会议定义的外部有效性和潜在影响，方法是比较根据柏林儿科急性肺损伤共识会议和美国欧洲共识会议标准在多学科PICU住院的儿童急性呼吸窘迫综合征的病例数和死亡率。设计：回顾性队列研究。设置：大学附属PICU三级护理患者：所有在2009年3月至2013年4月间入院的符合急性呼吸窘迫综合征纳入标准的患者。干预：无。测量和主要结果：4,764名住进ICU的患者，278例(5.8%)符合儿科急性肺损伤共识会议儿科急性呼吸窘迫综合征标准，死亡率为22.7%。143例(32.2%)符合柏林标准，134例(30.6%)符合美欧共识会议标准。所有符合美欧共识会议标准的患者和141名(98.6%)符合柏林标准的患者也符合儿科急性肺损伤共识会议标准。符合儿科急性肺损伤共识会议但不符合柏林标准的137名患者的总死亡率为13.1%，但有29名患者患有严重急性呼吸窘迫综合征，死亡率为31.0%。在急性呼吸窘迫综合征发作时，根据柏林标准和儿科急性肺损伤共识会议的标准，轻度或中度急性呼吸窘迫综合征的死亡率差异很小(分别为32.4%和25.0%)，但严重急性呼吸窘迫综合征的死亡率较高(柏林，43.6%；儿科急性肺损伤共识会议，37.0%)。急性呼吸窘迫综合征发病24小时后，严重急性呼吸窘迫综合征的出现(柏林或儿科急性肺损伤共识会议)与近50%的死亡率相关。结论：应用儿科急性肺损伤共识会议对急性呼吸窘迫综合征的定义有可能显著增加确诊的急性呼吸窘迫综合征患者的数量，总体死亡率较低。然而，严重急性呼吸窘迫综合征与极高的死亡率有关，特别是在首次诊断后24小时出现的情况下。
Objective: The Pediatric Acute Lung Injury Consensus Conference has developed a pediatric-specific definition of acute respiratory distress syndrome, which is a significant departure from both the Berlin and American European Consensus Conference definitions. We sought to test the external validity and potential impact of the Pediatric Acute Lung Injury Consensus Conference definition by comparing the number of cases of acute respiratory distress syndrome and mortality rates among children admitted to a multidisciplinary PICU when classified by Pediatric Acute Lung Injury Consensus Conference, Berlin, and American European Consensus Conference criteria.Design: Retrospective cohort study.Setting: Tertiary care, university-affiliated PICU.Patients: All patients admitted between March 2009 and April 2013 who met inclusion criteria for acute respiratory distress syndrome.Interventions: None.Measurements and Main Results: Of 4,764 patients admitted to the ICU, 278 (5.8%) met Pediatric Acute Lung Injury Consensus Conference pediatric acute respiratory distress syndrome criteria with a mortality rate of 22.7%. One hundred forty-three (32.2% mortality) met Berlin criteria, and 134 (30.6% mortality) met American European Consensus Conference criteria. All patients who met American European Consensus Conference criteria and 141 (98.6%) patients who met Berlin criteria also met Pediatric Acute Lung Injury Consensus Conference criteria. The 137 patients who met Pediatric Acute Lung Injury Consensus Conference but not Berlin criteria had an overall mortality rate of 13.1%, but 29 had severe acute respiratory distress syndrome with 31.0% mortality. At acute respiratory distress syndrome onset, there was minimal difference in mortality between mild or moderate acute respiratory distress syndrome by both Berlin (32.4% vs 25.0%, respectively) and Pediatric Acute Lung Injury Consensus Conference (16.7% vs 18.6%, respectively) criteria, but higher mortality for severe acute respiratory distress syndrome (Berlin, 43.6%; Pediatric Acute Lung Injury Consensus Conference, 37.0%). Twenty-four hours after acute respiratory distress syndrome onset, the presence of severe acute respiratory distress syndrome (using either Berlin or Pediatric Acute Lung Injury Consensus Conference) was associated with nearly 50% mortality.Conclusions: Applying the Pediatric Acute Lung Injury Consensus Conference definition of acute respiratory distress syndrome has the potential to significantly increase the number of acute respiratory distress syndrome patients identified, with a lower overall mortality rate. However, severe acute respiratory distress syndrome is associated with extremely high mortality, particularly if present at 24 hours after initial diagnosis.