TABLE 5.
Diagnosis of Possible Pediatric Acute Respiratory Distress Syndrome and At-Risk for Pediatric Acute Respiratory Distress Syndrome (Definition Statement 1.5.3; Definition Statement 1.7.2; Definition Statement 11.2)
| Age | Exclude patients with perinatal lung disease |
| Timing | Within 7 d of known clinical insult |
| Origin of edema | Not fully explained by cardiac failure or fluid overload |
| Chest imaging (DS 1.5.2) | New opacities (unilateral or bilateral) consistent with acute pulmonary parenchymal disease and which are not due primarily to atelectasis or effusiona |
| Oxygenationb threshold to diagnose possible PARDS for children on nasal respiratory supportc (DS 1.5.1) | |
| Nasal continuous airway positive pressure/bilevel positive airway pressure or high-flow nasal cannula (≥ 1.5 L/kg/min or ≥ 30 L/min): Pao2/Fio2 ≤ 300 or Spo2/Fio2 ≤ 250 | |
| Oxygenationb threshold to diagnose at-risk for PARDS | |
| Any interface: Oxygen supplementationd to maintain Spo2 ≥ 88% but not meeting definition for PARDS or possible PARDS | |
| Special populations | |
| Cyanotic heart disease | Above criteria, with acute deterioration in oxygenation not explained by cardiac disease |
| Chronic lung disease | Above criteria, with acute deterioration in oxygenation from baseline |
DS = definition statement, PARDS = pediatric acute respiratory distress syndrome, Spo2 = pulse oximeter oxygen saturation.
Children in resource-limited environments where imaging is not available who otherwise meet possible 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%.
Children on nasal noninvasive ventilation (NIV) or high-flow nasal cannula are not eligible for PARDS but are considered to have possible PARDS when this oxygenation threshold is met.
Oxygen supplementation is defined as Fio2 > 21% on invasive mechanical ventilation; or Fio2 > 21% on NIV; or “oxygen flow” from a mask or cannula that exceeds these age-specific thresholds: ≥ 2 L/min (age < 1 yr), ≥ 4 L/min (age 1–5 yr), ≥ 6 L/min (age 6–10 yr), or ≥ 8 L/min (age > 10 yr). For children on a mask or cannula, oxygen flow calculated as Fio2 × flow rate (L/min) (e.g., 6 L/min flow at 0.35 Fio2 = 2.1 L/min).
Additional note: Possible PARDS and at-risk for PARDS should not be diagnosed in children with respiratory failure solely from airway obstruction (e.g., critical asthma, virus-induced bronchospasm). The corresponding definition statement numbers are indicated in parentheses.