Skip to main content
SpringerLink
Log in

Pediatric Acute Respiratory Distress Syndrome: Definition and Epidemiology

  • Chapter
  • First Online:
Pediatric Acute Respiratory Distress Syndrome

Abstract

In 1821, Laennec described in his “Treatise on Diseases of the Chest” probably the first published description of ARDS. It was not until 1967, in a landmark article published in Lancet, that the term acute respiratory distress syndrome (ARDS) was mentioned. Like other clinical syndromes, ARDS lacks a definitive gold standard for diagnosis. In 1994, the American European Consensus Conference (AECC) defined ARDS as a syndrome of inflammation and increased permeability in the lungs that is associated with a constellation of clinical, radiologic, and physiologic abnormalities that cannot be explained by, but may coexist with, left atrial or pulmonary capillary hypertension. While this definition was used for nearly 30 years, there were several limitations of the AECC definition of ARDS related to the influence of ventilator settings on hypoxemia, timing of disease, noninvasive ventilation, defining a spectrum of hypoxemia severity in ARDS, and how to specifically handle left ventricular dysfunction. These limitations were addressed by the Berlin definition in 2012. While some of these issues are common between adults and children with ARDS, pediatric-specific considerations were not included in either Berlin or AECC definitions. In 2015, the Pediatric Acute Lung Injury Consensus Conference (PALICC) published specific definitions for pediatric ARDS (PARDS) and those gauged to be at risk for PARDS, as well as recommendations regarding management and suggested priorities for future research.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967;2(7511):319–23.

    Article  CAS  PubMed  Google Scholar 

  2. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R. The American-European consensus conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149(3 pt 1):818–24.

    Article  CAS  PubMed  Google Scholar 

  3. Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, Brochard L, Brower R, Esteban A, Gattinoni L, et al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012;38:1573–82.

    Article  PubMed  Google Scholar 

  4. Force ADT, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS, et al. JAMA. 2012;307:2526–33.

    Google Scholar 

  5. Thomas NJ, Jouvet P, Willson D. Acute lung injury in children – kids really aren’t just “little adults”. Pediatr Crit Care Med. 2013;14(4):429–32.

    Article  PubMed  Google Scholar 

  6. Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the pediatric acute lung injury consensus conference. Pediatr Crit Care Med. 2015;16(5):428–39.

    Article  Google Scholar 

  7. De Luca D, van Kaam AH, Tingay DG, Courtney SE, Danhaive O, Carnielli VP, Zimmermann LJ, Kneyber MCJ, Tissieres P, Brierley J, Conti G, Pillow JJ, Rimensberger PC. The Montreux definition of neonatal ARDS: biological and clinical background behind the description of a new entity. Lancet Respir Med. 2017 Aug;5(8):657–66.

    Article  PubMed  Google Scholar 

  8. Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, Stern EJ, Hudson LD. Incidence and outcomes of acute lung injury. N Engl J Med. 2005;353(16):1685–93.

    Article  CAS  PubMed  Google Scholar 

  9. Zimmerman JJ, Akhtar SR, Caldwell E, Rubenfeld GD. Incidence and outcomes of pediatric acute lung injury. Pediatrics. 2009;124(1):87–95.

    Article  PubMed  Google Scholar 

  10. Kochanek KD, Xu J, Murphy SL, Minino AM, Kung H. Deaths: final data for 2009. Natl Vital Stat Rep. 2012;60(3):1–117.

    Google Scholar 

  11. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010;375(9730):1969–87.

    Article  PubMed  Google Scholar 

  12. Causes of Death 2008. Summary tables. In: World Health Organization; 2011. https://www.cdc.gov/injury/wisqars/pdf/10lcd-age-grp-us-2008-a.pdf.

  13. Hudson LD, Milberg JA, Anardi D, Maunder RJ. Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care Med. 1995;151(2):293–301.

    Article  CAS  PubMed  Google Scholar 

  14. Bersten AD, Edibam C, Hunt T, Moran J, Australian, New Zealand Intensive Care Society, Clinical Trials Group. Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian states. Am J Respir Crit Care Med. 2002;165(4):443–8.

    Article  PubMed  Google Scholar 

  15. Dahlem P, van Aalderen WMC, Hamaker ME, Dijkgraaf MGW, Bos AP. Incidence and short-term outcome of acute lung injury in mechanically ventilated children. Eur Respir J. 2003;22(6):980–5.

    Article  CAS  PubMed  Google Scholar 

  16. Yu W-L, Lu Z-J, Wang Y, Shi L-P, Kuang F-W, Qian S-Y, Zeng Q-Y, Xie M-H, Zhang G-Y, Zhuang D-Y, et al. The epidemiology of acute respiratory distress syndrome in pediatric intensive care units in China. Intensive Care Med. 2009;35(1):136–43.

    Article  PubMed  Google Scholar 

  17. Irish Critical Care Trials Group (ICCT). Acute lung injury and the acute respiratory distress syndrome in Ireland: a prospective audit of epidemiology and management. Crit Care. 2008;12(1):R30.

    Article  Google Scholar 

  18. Iscimen R, Cartin-Ceba R, Yilmaz M, Khan H, Hubmayr RD, Afessa B, Gajic O. Risk factors for the development of acute lung injury in patients with septic shock: an observational cohort study. Crit Care Med. 36(5):1518–22.

    Article  PubMed  Google Scholar 

  19. Gajic O, Dabbagh O, Park PK, Adesanya A, Chang SY, Hou P, Anderson H, Hoth JJ, Mikkelsen ME, Gentile NT, et al. Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study. Am J Respir Crit Care Med. 2011;183(4):462–70.

    Article  PubMed  Google Scholar 

  20. Gajic O, Moore SB. Transfusion-related acute lung injury. Mayo Clin Proc. 2005;80(6):766–70.

    Article  CAS  PubMed  Google Scholar 

  21. Marik PE, Corwin HL. Acute lung injury following blood transfusion: expanding the definition. Crit Care Med. 2008;36(11):3080–4.

    Article  PubMed  Google Scholar 

  22. Sedy J, Zicha J, Kunes J, Jendelova P, Sykova E. Mechanisms of neurogenic pulmonary edema development. Physiol Res. 2008;57(4):499–506.

    CAS  PubMed  Google Scholar 

  23. Meyer RJ, Theodorou AA, Berg RA. Childhood drowning. Pediatr Rev. 2006;27(5):163–8.. quiz 169

    Article  PubMed  Google Scholar 

  24. Erickson S, Schibler A, Numa A, Nuthall G, Yung M, Pascoe E, Wilkins B, Group PS. Society AaNZIC: acute lung injury in pediatric intensive care in Australia and New Zealand: a prospective, multicenter, observational study. Pediatr Crit Care Med. 2007;8(4):317–23.

    PubMed  Google Scholar 

  25. Flori HR, Glidden DV, Rutherford GW, Matthay MA. Pediatric acute lung injury: prospective evaluation of risk factors associated with mortality. Am J Respir Crit Care Med. 2005;171(9):995–1001.

    Article  PubMed  Google Scholar 

  26. Kaufman BD, Shaddy RE, Shirali GS, Tanel R, Towbin JA. Assessment and management of the failing heart in children. Cardiol Young. 2008;18(Suppl 3):63–71.

    Article  PubMed  Google Scholar 

  27. Khemani RG, Rubin S, Belani S, Leung D, Erickson S, Smith LS, Zimmerman JJ, Newth CJ. Pulse oximetry vs. PaO2 metrics in mechanically ventilated children: Berlin definition of ARDS and mortality risk. Intensive Care Med. 2015;41(1):94–102.

    Article  PubMed  Google Scholar 

  28. Khemani RG, Conti D, Alonzo TA, Bart RD, Newth CJL. Effect of tidal volume in children with acute hypoxemic respiratory failure. Intensive Care Med. 2009;35(8):1428–37.

    Article  PubMed  Google Scholar 

  29. Ghuman AK, Newth CJL, Khemani RG. The association between the end tidal alveolar dead space fraction and mortality in pediatric acute hypoxemic respiratory failure. Pediatr Crit Care Med. 2012;13(1):11–5.

    Article  PubMed  Google Scholar 

  30. Trachsel D, McCrindle BW, Nakagawa S, Bohn D. Oxygenation index predicts outcome in children with acute hypoxemic respiratory failure. Am J Respir Crit Care Med. 2005;172(2):206–11.

    Article  PubMed  Google Scholar 

  31. Khemani RG, Thomas NJ, Venkatachalam V, Scimeme JP, Berutti T, Schneider JB, Ross PA, Willson DF, Hall MW, Newth CJL et al: Comparison of SpO2 to PaO2 based markers of lung disease severity for children with acute lung injury. 2012, 40(4):1309–1316.

    Google Scholar 

  32. Thomas NJ, Shaffer ML, Willson DF, Shih M-C, Curley MAQ. Defining acute lung disease in children with the oxygenation saturation index. Pediatr Crit Care Med. 2010;11(1):12–7.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Britos M, Smoot E, Liu KD, Thompson BT, Checkley W, Brower RG, Investigators NIoHARDSN. The value of positive end-expiratory pressure and Fio2 criteria in the definition of the acute respiratory distress syndrome. Crit Care Med. 2011;39(9):2025–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. ARDSnet. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The acute respiratory distress syndrome Network. N Engl J Med. 2000;342(18):1301–8.

    Article  Google Scholar 

  35. Santschi M, Jouvet P, Leclerc F, Gauvin F, Newth CJ, Carroll C, Flori H, Tasker RC, Rimensberger P, Randolph A, et al. Acute lung injury in children:therapeutic practice and feasibility of international clinical trials. Pediatr Crit Care Med. 2010;11(6):681–9.

    Article  PubMed  Google Scholar 

  36. Khemani RG, Sward K, Morris A, Dean JM, Newth CJL. CPCCRN: variability in usual care mechanical ventilation for pediatric acute lung injury: the potential benefit of a lung protective computer protocol. Intensive Care Med. 2011;37(11):1840–8.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Khemani RG, Parvathaneni K, Yehya N, Bhalla AK, Thomas NJ, Newth CJL. PEEP lower than the ARDS network protocol is associated with higher pediatric ARDS mortality. Am J Respir Crit Care Med. 2018 Jan 26;198:77.

    Article  PubMed  PubMed Central  Google Scholar 

  38. López-Fernández Y, AM-d A, de la Oliva P, Modesto V, Sánchez JI, Parrilla J, Arroyo MJ, Reyes SB, Pons-Ódena M, López-Herce J, et al. Pediatric acute lung injury epidemiology and natural history study: incidence and outcome of the acute respiratory distress syndrome in children. Crit Care Med. 2012;40:3238.

    Article  PubMed  Google Scholar 

  39. Willson DF, Thomas NJ, Markovitz BP, Bauman LA, DiCarlo JV, Pon S, Jacobs BR, Jefferson LS, Conaway MR, Egan EA, et al. Effect of exogenous surfactant (calfactant) in pediatric acute lung injury: a randomized controlled trial. JAMA. 2005;293(4):470–6.

    Article  CAS  PubMed  Google Scholar 

  40. Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD, Slutsky AS, Pullenayegum E, Zhou Q, Cook D, et al. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA. 2010;303(9):865–73.

    Article  CAS  PubMed  Google Scholar 

  41. Curley MAQ, Hibberd PL, Fineman LD, Wypij D, Shih M-C, Thompson JE, Grant MJC, Barr FE, Cvijanovich NZ, Sorce L, et al. Effect of prone positioning on clinical outcomes in children with acute lung injury: a randomized controlled trial. JAMA. 2005;294(2):229–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Quartin AA, Campos MA, Maldonado DA, Ashkin D, Cely CM, Schein RMH. Acute lung injury outside of the ICU: incidence in respiratory isolation on a general ward. Chest. 2009;135(2):261–8.

    Article  PubMed  Google Scholar 

  43. Ferguson ND, Frutos-Vivar F, Esteban A, Gordo F, Honrubia T, Peñuelas O, Algora A, García G, Bustos A, Rodríguez I. Clinical risk conditions for acute lung injury in the intensive care unit and hospital ward: a prospective observational study. Crit Care. 2007;11(5):R96.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kneyber MCJ, Brouwers AGA, Caris JA, Chedamni S, Plötz FB. Acute respiratory distress syndrome: is it underrecognized in the pediatric intensive care unit? Intensive Care Med. 2008;34(4):751–4.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Khemani RG, Patel NR, Bart RD, Newth CJL. Comparison of the pulse oximetric saturation/fraction of inspired oxygen ratio and the PaO2/fraction of inspired oxygen ratio in children. Chest. 2009;135(3):662–8.

    Article  PubMed  Google Scholar 

  46. Kallstrom TJ. American association for respiratory C: AARC clinical practice guideline: oxygen therapy for adults in the acute care facility – 2002 revision & update. Respir Care. 2002, 47(6):717–20.

    Google Scholar 

  47. Wettstein RB, Shelledy DC, Peters JI. Delivered oxygen concentrations using low-flow and high-flow nasal cannulas. Respir Care. 2005;50(5):604–9.

    PubMed  Google Scholar 

  48. Pruitt WC, Jacobs M. Breathing lessons: basics of oxygen therapy. Nursing. 2003;33(10):43–5.

    Article  PubMed  Google Scholar 

  49. Levitt JE, Calfee CS, Goldstein BA, Vojnik R, Matthay MA. Early acute lung injury: criteria for identifying lung injury prior to the need for positive pressure ventilation. Crit Care Med. 2013;41(8):1929–37.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1334–49.

    Article  CAS  PubMed  Google Scholar 

  51. Bindl L, Dresbach K, Lentze MJ. Incidence of acute respiratory distress syndrome in German children and adolescents: a population-based study. Crit Care Med. 2005;33(1):209–312.

    Article  PubMed  Google Scholar 

  52. Li G, Malinchoc M, Cartin-Ceba R, Venkata CV, Kor DJ, Peters SG, Hubmayr RD, Gajic O. Eight-year trend of acute respiratory distress syndrome: a population-based study in Olmsted County, Minnesota. Am J Respir Crit Care Med. 2011;183(1):59–66.

    Article  PubMed  Google Scholar 

  53. Luhr OR, Antonsen K, Karlsson M, Aardal S, Thorsteinsson A, Frostell CG, Bonde J. Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF study group. Am J Respir Crit Care Med. 1999;159(6):1849–61.

    Article  CAS  PubMed  Google Scholar 

  54. Brun-Buisson C, Minelli C, Bertolini G, Brazzi L, Pimentel J, Lewandowski K, Bion J, Romand J-A, Villar J, Thorsteinsson A, et al. Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study. Intensive Care Med. 2004;30(1):51–61.

    Article  PubMed  Google Scholar 

  55. Li Y, Wang Q, Chen H, Gao H-M, Zhou T, Qian S-Y. Epidemiological features and risk factor analysis of children with acute lung injury. World J Pediatr. 2012;8(1):43–6.

    Article  CAS  PubMed  Google Scholar 

  56. Hu X, Qian S, Xu F, Huang B, Zhou D, Wang Y, Li C, Fan X, Lu Z, Sun B, et al. Incidence, management and mortality of acute hypoxemic respiratory failure and acute respiratory distress syndrome from a prospective study of Chinese paediatric intensive care network. Acta Paediatr. 2010;99(5):715–21.

    Article  CAS  PubMed  Google Scholar 

  57. Bindl L, Buderus S, Dahlem P, Demirakca S, Goldner M, Huth R, Kohl M, Krause M, Kühl P, Lasch P, et al. Gender-based differences in children with sepsis and ARDS: the ESPNIC ARDS database group. Intensive Care Med. 2003;29(10):1770–3.

    Article  PubMed  Google Scholar 

  58. Johnston CJ, Rubenfeld GD, Hudson LD. Effect of age on the development of ARDS in trauma patients. Chest. 2003;124(2):653–9.

    Article  PubMed  Google Scholar 

  59. Agarwal R, Srinivas R, Nath A, Jindal SK. Is the mortality higher in the pulmonary vs the extrapulmonary ARDS? A meta analysis. Chest. 2008;133(6):1463–73.

    Article  PubMed  Google Scholar 

  60. Sevransky JE, Martin GS, Mendez-Tellez P, Shanholtz C, Brower R, Pronovost PJ, Needham DM. Pulmonary vs nonpulmonary sepsis and mortality in acute lung injury. Chest. 2008;134(3):534–8.

    Article  PubMed  Google Scholar 

  61. Parvathaneni K, Belani S, Leung D, Newth CJ, Khemani RG. Evaluating the performance of the pediatric acute lung injury consensus conference definition of acute respiratory distress syndrome. Pediatr Crit Care Med. 2017;18(1):17–25.

    Article  PubMed  Google Scholar 

  62. Yehya N, Servaes S, Thomas NJ. Characterizing degree of lung injury in pediatric acute respiratory distress syndrome. Crit Care Med. 2015;43(5):937–46.

    Article  PubMed  Google Scholar 

  63. Rowan CM, Smith LS, Loomis A, et al. Pediatric acute respiratory distress syndrome in pediatric allogeneic hematopoietic stem cell transplants: a multicenter study. Pediatr Crit Care Med. 2017;18(4):304–9.

    Article  PubMed  Google Scholar 

  64. Wong JJ, Phan HP, Phumeetham S, et al. Risk stratification in pediatric acute respiratory distress syndrome: a multicenter observational study. Crit Care Med. 2017;45(11):1820–8.

    Article  PubMed  Google Scholar 

  65. Wong JJ, Jit M, Sultana R, et al. Mortality in pediatric acute respiratory distress syndrome: a systematic review and Meta-analysis. J Intensive Care Med. 2017;885066617705109

    Google Scholar 

  66. Khemani RG, Smith L, Lopez-Fernandez YM, Kwok J, Morzov R, Klein MJ, Yehya N, Willson D, Kneyber MCJ, Lillie J, Fernandez A, Newth CJL, Jouvet P, Thomas NJ. Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. Pediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE) Investigators; pediatric acute lung injury and Sepsis Investigators (PALISI) Network. Lancet Respir Med. 2019;7:115–28.

    Google Scholar 

  67. Delucchi K, Famous KR, Ware LB, Parsons PE, Thompson BT, Calfee CS, Network ARDS. Stability of ARDS subphenotypes over time in two randomised controlled trials. Thorax. 2018;73(5):439–45.

    Article  PubMed  Google Scholar 

  68. Zhao Z, Wickersham N, Kangelaris KN, May AK, Bernard GR, Matthay MA, Calfee CS, Koyama T, Ware LB. External validation of a biomarker and clinical prediction model for hospital mortality in acute respiratory distress syndrome. Intensive Care Med. 2017;43(8):1123–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Calfee CS. ARDS in 2015: new clinical directions, new biological insights. Lancet Respir Med. 2015 Dec;3(12):912–3.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA

    Fernando Beltramo & Robinder G. Khemani

Authors
  1. Fernando Beltramo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robinder G. Khemani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robinder G. Khemani .

Editor information

Editors and Affiliations

  1. Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH, USA

    Steven L. Shein

  2. Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA

    Alexandre T. Rotta

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Beltramo, F., Khemani, R.G. (2020). Pediatric Acute Respiratory Distress Syndrome: Definition and Epidemiology. In: Shein, S., Rotta, A. (eds) Pediatric Acute Respiratory Distress Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-030-21840-9_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-21840-9_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-21839-3

  • Online ISBN: 978-3-030-21840-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation