Seven-Day Profile Publication

Intensive Care Medicine

, Volume 39, Issue 12, pp 2083-2091

The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood: multicenter evaluation and expert consensus

  • Daniele De LucaAffiliated withTerapia Intensiva Pediatrica–DEA, Policlinico Universitario “A. Gemelli”–Università Cattolica del Sacro CuoreNeonatal Intensive Care Unit, CHU Antoine Béclère, South Paris University Teaching HospitalsPediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart Email author 
  • , Marco PiastraAffiliated withPediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart
  • , Giovanna ChidiniAffiliated withPediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico
  • , Pierre TissieresAffiliated withPediatric Intensive Care Unit, CHU Kremlin-Bicetre, South Paris University Teaching Hospitals
  • , Edoardo CalderiniAffiliated withPediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico
  • , Sandrine EssouriAffiliated withPediatric Intensive Care Unit, CHU Kremlin-Bicetre, South Paris University Teaching Hospitals
  • , Alberto Medina VillanuevaAffiliated withPediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario de Asturias
  • , Ana Vivanco AllendeAffiliated withPediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario de Asturias
  • , Marti Pons-OdenaAffiliated withPediatric Intensive Care and Intermediate Care Unit, Department of Pediatrics, Hospital Universitari Sant Joan de Déu
    • , Luis Perez-BaenaAffiliated withPediatric Intensive Care and Intermediate Care Unit, Department of Pediatrics, Hospital Universitari Sant Joan de Déu
    • , Michael HermonAffiliated withDivision of Neonatology, Intensive Care and Neuro-pediatrics, Medical University of Vienna
    • , Ascanio TridenteAffiliated withIntensive 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
    • , Giorgio ContiAffiliated withPediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart
    • , Massimo AntonelliAffiliated withGeneral Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart
    • , Martin KneyberAffiliated withPediatric Intensive Care Unit, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, University of GroningenPediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart
    • , On behalf of Respiratory Section of the European Society for Pediatric Neonatal Intensive Care (ESPNIC)Affiliated withPediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart

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.

Keywords

ARDS Children Diagnostic criteria