Rudolph, M.W. (2017) Performance of the Pediatric Acute Lung Injury Consensus Conference (PALICC) definition of acute respiratory distress syndrome. thesis, Medicine.
Full text available on request.Abstract
Background Acute respiratory distress syndrome (ARDS) is known for 50 years now. Over these decades, there has been made progress in understanding this disease which is still one of the most lethal ones on the intensive care units worldwide. There are multiple consecutive definitions for ARDS, including the American-European Consensus Conference (AECC) definition from 1994 and the Berlin definition from 2012. These definitions were exclusively made by the adult critical care community. In 2015, the Pediatric Acute Lung Injury Consensus Conference (PALICC) published the first definition specifically targeted at pediatric ARDS (PARDS). The goal of this study is to study the performance of this new definition compared to the previous adult definitions. Material and methods This is a retrospective study performed of children admitted between January 2014 and December 2016 to the pediatric intensive care unit (PICU) of the University Medical Centre Groningen (UMCG) in the Netherlands. All patients who received invasive mechanical ventilation (IMV) for over 24 hours were screened for the criteria of the 3 definitions (AECC, Berlin and PALICC). Patients with home ventilation, a cyanotic heart disease or receiving ECLS on the moment of screening were excluded from this study. Outcome measures are: mortality (primary), admission duration and duration of receiving mechanical ventilation (secondary outcomes). Results Of the 2,433 patients (mortality 3.4%) admitted to the PICU, 332 patients (13.6%) met the PALICC criteria (mortality of 8.4%). Of these 332 patients, 162 patients also met Berlin and AECC criteria (mortality 8.8%). There were 9 patients who met the Berlin and AECC criteria but not the PALICC criteria. Of the 172 patients who met the PALICC criteria but not the Berlin/AECC criteria, 160 patients (95.2%) did only have unilateral infiltrates on chest radiograph and 12 patients (7.1%) did not have an arterial blood gas performed. The use of the PALICC definition at onset predicted the mortality the best (AUROC 0.55). No significant differences were found between uni- and bilateral infiltrates on mortality, admission duration nor ventilation duration. Conclusion The PALICC definition identified more cases of PARDS than the other criteria, mostly because the absence of bilateral infiltrates on chest radiograph, and predicts mortality the best when severity is stratified at onset of the disease. The PALICC stratification after 48 hours differentiated the best in duration of mechanical ventilation and admission duration.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor: and Kneyber, dr. M.C.J. pediatric intensivist and Department: pediatric intensive care unit, University Medica |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:45 |
| Last Modified: | 25 Jun 2020 10:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/618 |
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