TABLE 4.
Diagnosis of Pediatric Acute Respiratory Distress Syndrome (Definition Statement 1.1; Definition Statement 1.7.1)
| Age (DS 1.1) | Exclude patients with perinatal lung disease | ||
| Timing (DS 1.2) | Within 7 d of known clinical insult | ||
| Origin of edema (DS 1.3) | Not fully explained by cardiac failure or fluid overload | ||
| Chest imaging (DS 1.3) | New opacities (unilateral or bilateral) consistent with acute pulmonary parenchymal disease and which are not due primarily to atelectasis or pleural effusiona | ||
| Oxygenationb (DS 1.4.1) | IMV: OI ≥ 4 or OSI ≥ 5 | ||
| NIVc: Pao2/Fio2 ≤ 300 or Spo2/Fio2 ≤ 250 | |||
| Stratification of PARDS severity: Apply ≥ 4 hr after initial diagnosis of PARDS (DS 1.4.4) | |||
| IMV-PARDS: (DS 1.4.1) | Mild/moderate: OI < 16 or OSI < 12 (DS 1.4.5) | Severe: OI ≥ 16 or OSI ≥ 12 (DS 1.4.5) | |
| NIV-PARDSc (DS 1.4.2; DS 1.4.3) | Mild/moderate NIV-PARDS: Pao2/Fio2 > 100 or Spo2/Fio2 > 150 | Severe NIV-PARDS: Pao2/Fio2 ≤ 100 or Spo2/Fio2 ≤ 150 | |
| Special populations d | |||
| Cyanotic heart disease (DS 1.6.1; DS 1.6.2) | Above criteria, with acute deterioration in oxygenation not explained by cardiac disease | ||
| Chronic lung disease (DS 1.6.3; DS 1.6.4) | Above criteria, with acute deterioration in oxygenation from baseline | ||
DS = definition statement, IMV = invasive mechanical ventilation, NIV = noninvasive ventilation, OI = oxygenation index, OSI = oxygenation saturation index, PARDS = pediatric acute respiratory distress syndrome, Spo2 = pulse oximeter oxygen saturation.
Children in resource-limited settings where imaging is not available who otherwise meet PARDS criteria are considered to have possible PARDS.
Oxygenation should be measured at steady state and not during transient desaturation episodes. When Spo2 is used, ensure that Spo2 is ≤ 97%.
OI = mean airway pressure (MAP) (cm H2O) × Fio2/Pao2 (mm Hg).
OSI = MAP (cm H2O) × Fio2/Spo2.
Diagnosis of PARDS on NIV (NIV-PARDS) requires full facemask interface with continuous airway positive pressure/positive end-expiratory pressure ≥ 5 cm H2O.
Stratification of PARDS severity does not apply to these populations.
Additional note: Possible PARDS and At-Risk for PARDS should not be diagnosed in children with respiratory failure solely from airways obstruction (e.g., critical asthma, virus-induced bronchospasm). The corresponding definition statement numbers are indicated in parentheses.