Epidemiology and Outcomes of Acute Respiratory Distress Syndrome in Children According to the Berlin Definition: A Multicenter Prospective Study

Epidemiology and Outcomes of Acute Respiratory Distress Syndrome in Children According to the Berlin Definition: A Multicenter Prospective Study

Author Barreira, Eliane R. Google Scholar
Munoz, Gabriela O. C. Google Scholar
Cavalheiro, Priscilla O. Google Scholar
Suzuki, Adriana S. Google Scholar
Degaspare, Natalia V. Google Scholar
Shieh, Huei H. Google Scholar
Martines, Joao A. D. S. Google Scholar
Ferreira, Juliana C. Google Scholar
Lane, Christianne Google Scholar
Carvalho, Werther B. Google Scholar
Gilio, Alfredo Elias Google Scholar
Precioso, Alexander R. Google Scholar
Brazilian Pediat Acute Resp Google Scholar
Institution Universidade de São Paulo (USP)
Hosp Israelita Albert Einstein
Universidade Federal de São Paulo (UNIFESP)
Univ So Calif
Inst Butantan
Abstract Objectives: in 2012, a new acute respiratory distress syndrome definition was proposed for adult patients. It was later validated for infants and toddlers. Our objective was to evaluate the prevalence, outcomes, and risk factors associated with acute respiratory distress syndrome in children up to 15 years according to the Berlin definition.Design: A prospective, multicenter observational study from March to September 2013.Setting: Seventy-seven PICU beds in eight centers: two private hospitals and six public academic hospitals in Brazil.Patients: All children aged 1 month to 15 years admitted to the participating PICUs in the study period.Interventions: None.Measurements and Main Results: All children admitted to the PICUs were daily evaluated for the presence of acute respiratory distress syndrome according to the American-European - Consensus Conference and Berlin definitions. of the 562 patients included, acute respiratory distress syndrome developed in 57 patients (10%) and 58 patients (10.3%) according to the Berlin definition and the American-European Consensus Conference definition, respectively. Among patients with acute respiratory distress syndrome according to the Berlin definition, nine patients (16%) were mild, 21 (37%) were moderate, and 27 (47%) were severe. Compared with patients without acute respiratory distress syndrome, patients with acute respiratory distress syndrome had significantly higher severity scores, longer PICU and hospital length of stay, longer duration of mechanical ventilation, and higher mortality (p < 0.001). the presence of two or more comorbidities and admission for medical reasons were associated with development of acute respiratory distress syndrome. Comparisons across the three the Berlin categories showed significant differences in the number of ventilator-free days (21, 20, and 5 d, p = 0.001) and mortality for severe acute respiratory distress syndrome (41%) in comparison with mild (0) and moderate (15%) acute respiratory distress syndrome(p = 0.02). No differences in PICU or hospital stay were observed across the groups.Conclusions: the Berlin definition can identify a subgroup of patients with distinctly worse outcomes, as shown by the increased mortality and reduced number of ventilator-free days in pediatric patients with severe acute respiratory distress syndrome.
Keywords critical care
respiration, artificial
respiratory distress syndrome, adults
respiratory insufficiency
Language English
Sponsor Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Date 2015-05-01
Published in Critical Care Medicine. Philadelphia: Lippincott Williams & Wilkins, v. 43, n. 5, p. 947-953, 2015.
ISSN 0090-3493 (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent 947-953
Origin http://dx.doi.org/10.1097/CCM.0000000000000866
Access rights Closed access
Type Article
Web of Science ID WOS:000353061000019
URI http://repositorio.unifesp.br/handle/11600/39066

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