Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2)

• Type of Material: Article
• Authors: Guillaume Emeriaud, Université de Montréal; Yolanda M López-Fernández, Biocruces-Bizkaia Health Research Institute; Narayan Prabhu Iyer, Keck School of Medicine of USC; Melania M Bembea, Johns Hopkins School of Medicine; Asya Agulnik, St. Jude Children's Research Hospital; Ryan P Barbaro, University of Michigan Medical School; Florent Baudin, Réanimation Pédiatrique, Lyon; Anoopindar Bhalla, Keck School of Medicine of USC; Werther Brunow De Carvalho, Universidade de São Paulo; Christopher L Carroll, Connecticut Children's Hospital; Ira M Cheifetz, University Hospitals Rainbow Babies & Children's Hospital; Mohammod J Chisti, International Centre for Diarrhoeal Disease Research Bangladesh; Pablo Cruces, Universidad Andrés Bello; Martha AQ Curley, University of Pennsylvania School of Nursing; Mary K Dahmer, University of Michigan, Ann Arbo; Heidi J Dalton, Inova Fairfax Medical Center; Simon J Erickson, Perth Children's Hospital; Sandrine Essouri, CHU Sainte-Justine - Le Centre Hospitalier Universitaire Mère-Enfant; Analía Fernández, Hospital General de Agudos Carlos G. Durand; Heidi R Flori, University of Michigan Medical School; Jocelyn Grunwell, Emory University; Philippe Jouvet, CHU Sainte-Justine - Le Centre Hospitalier Universitaire Mère-Enfant; Elizabeth Y Killien, University of Washington School of Medicine; Martin CJ Kneyber, Beatrix Kinderziekenhuis; Sapna R Kudchadkar, Johns Hopkins School of Medicine; Steven K Korang, Keck School of Medicine of USC; Jan Hau Lee, KK Women's And Children's Hospital; Duncan J Macrae, Sidra Medicine; Aline Maddux, University of Colorado School of Medicine; Vicent Modesto I Alapont, Hospital Universitari i Politècnic La Fe; Brenda M Morrow, University of Cape Town; Vinay M Nadkarni, University of Pennsylvania Perelman School of Medicine; Natalie Napolitano, The Children's Hospital of Philadelphia; Christopher JL Newth, Keck School of Medicine of USC; Marti Pons-Odena, Universitat de Barcelona; Michael W Quasney, University of Michigan Medical School; Prakadeshwari ]Rajapreyar, Medical College of Wisconsin; Jerome Rambaud, Armand-Trousseau Hospital; Adrienne G Randolph, Harvard Medical School; Peter Rimensberger, University of Geneva; Courtney M Rowan, Indiana University; Nelson L Sanchez-Pinto, Northwestern University Feinberg; Anil Sapru, University of California, Los Angeles; Michael Sauthier, Université de Montréal; Steve L Shein, Case Western Reserve University; Lincoln S Smith, University of Washington; Katerine Steffen, Stanford University; Muneyuki Takeuchi, Osaka Women's and Children's Hospital; Neal J Thomas, Penn State University; Sza Man Tse, Université de Montréal; Stacey Valentine, University of Massachusetts; Shan Ward, University of California San Francisco; Scott R Watson, University of Washington; Nadir Yehya, University of Pennsylvania; Jerry J Zimmerman, University of Washington; Robinder G Khemani, University of Southern California, Los Angeles
• Language: English
• Date: 2023-02-01
• Publisher: Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/PCC.0000000000003147
• Title of Journal or Parent Work: Pediatric Critical Care Medicine
• Volume: 24
• Issue: 2
• Start Page: 143
• End Page: 168
• Keywords: Humans; Respiratory Distress Syndrome; Respiration, Artificial; Consensus; Acute Lung Injury; Child
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

OBJECTIVES: We sought to update our 2015 work in the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PARDS), considering new evidence and topic areas that were not previously addressed. DESIGN: International consensus conference series involving 52 multidisciplinary international content experts in PARDS and four methodology experts from 15 countries, using consensus conference methodology, and implementation science. SETTING: Not applicable. PATIENTS: Patients with or at risk for PARDS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Eleven subgroups conducted systematic or scoping reviews addressing 11 topic areas: 1) definition, incidence, and epidemiology; 2) pathobiology, severity, and risk stratification; 3) ventilatory support; 4) pulmonary-specific ancillary treatment; 5) nonpulmonary treatment; 6) monitoring; 7) noninvasive respiratory support; 8) extracorporeal support; 9) morbidity and long-term outcomes; 10) clinical informatics and data science; and 11) resource-limited settings. The search included MEDLINE, EMBASE, and CINAHL Complete (EBSCOhost) and was updated in March 2022. Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to summarize evidence and develop the recommendations, which were discussed and voted on by all PALICC-2 experts. There were 146 recommendations and statements, including: 34 recommendations for clinical practice; 112 consensus-based statements with 18 on PARDS definition, 55 on good practice, seven on policy, and 32 on research. All recommendations and statements had agreement greater than 80%. CONCLUSIONS: PALICC-2 recommendations and consensus-based statements should facilitate the implementation and adherence to the best clinical practice in patients with PARDS. These results will also inform the development of future programs of research that are crucially needed to provide stronger evidence to guide the pediatric critical care teams managing these patients.