The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood: multicenter evaluation and expert consensus
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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DOI：
10.1007/s00134-013-3110-x
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发表时间：
2013-12-01
影响因子：
38.9
通讯作者：
Kneyber, Martin
中科院分区：
文献类型：
--
作者：
De Luca, Daniele;Piastra, Marco;Kneyber, Martin
一个新的急性呼吸窘迫综合征（ARDS）的定义最近已经发布：所谓的柏林定义（BD）有一些特点，可以使它适用于儿科。欧洲儿科新生儿重症监护学会（ESPNIC）呼吸科启动了一个项目，以评估BD在儿童早期的有效性。第二个目标是就临床工具达成共识这是一项国际性、多中心、回顾性研究，纳入了221名儿童[年龄大于30天，小于18个月;平均年龄6岁（2-13个月）]，因急性肺损伤（ALI）入住7家欧洲儿科重症监护室（PICU）患者根据两种定义分类如下：ALI，36例; ARDS，185例（用于美国-欧洲共识会议（AECC）定义）;轻度，36例;中度，97例;重度ARDS，88例（用于BD）。死亡率（轻度ARDS为13.9%;中度ARDS为11.3%;重度ARDS为25%，p = 0.04）和复合结局体外膜氧合（ECMO）/死亡率（13.9%为轻度ARDS，11.3%为中度ARDS; 28.4%，p < 0.01）在BD分类中不同，而使用先前的定义时它们是相似的。死亡率[HR 2.7（95% CI 1.1-7.1）]和ECMO/死亡率[HR 3（95% CI 1.1-7.9）]仅在重度ARDS类别中增加，在调整混杂因素后仍显着。无论使用何种定义，不同严重程度的PICU住院时间没有差异。评估X线片[ICC 0.6（95% CI 0.2-0.8）]和风险因素[ICC 0.92（95% CI 0.8-0.97）]的评分者之间存在显著一致性。BD对儿童的有效性与已报道的成人相似，主要是由于引入了“重度ARDS”类别。我们提供了临床工具，使用BD在儿科重症监护的临床实践，研究和卫生服务规划。
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.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.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)].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.