Top

Published in:

01-09-2018 | Editorial

‘Lumping or splitting’ in paediatric acute respiratory distress syndrome (PARDS)

Authors: Daniele De Luca, David A. Harrison, Mark J. Peters

Published in: Intensive Care Medicine | Issue 9/2018

Excerpt

Improvements in acute respiratory distress syndrome (ARDS) outcomes in adults have been achieved alongside demonstration of the superiority of low-tidal volume ventilation [1], the relative advantage of a restrictive fluid strategy [2] and the characterisation of the main effectors of ventilator-induced lung injury [3]. The heterogeneity of the group of patients defined as ‘ARDS’ on pragmatic criteria is widely recognized. ‘Lumping’ together patients with different ages, aetiologies, time courses, co-morbidities and broad categories of severity has so far been the norm in clinical trials. This undoubtedly assists in patient recruitment, and any positive trial results in such mixed populations are very likely to be robust and generalisable [4]. …

Network Acute Respiratory Distress Syndrome, Brower RG, Matthay MA et al (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308. https://doi.org/10.1056/NEJM200005043421801 CrossRef

National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL (2006) Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 354(24):2564–2575CrossRef

Amato MBP, Meade MO, Slutsky AS et al (2015) Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med 372:747–755. https://doi.org/10.1056/NEJMsa1410639 CrossRefPubMed

Gattinoni L, Marini JJ, Quintel M (2018) Time to rethink the approach to treating acute respiratory distress syndrome. JAMA 319:664–666. https://doi.org/10.1001/jama.2017.21900 CrossRefPubMed

Meade MO, Cook DJ, Guyatt GH et al (2008) Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 299:637–645. https://doi.org/10.1001/jama.299.6.637 CrossRefPubMed

Mercat A, Richard J-CM, Vielle B et al (2008) Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 299:646–655. https://doi.org/10.1001/jama.299.6.646 CrossRefPubMed

Goligher EC, Kavanagh BP, Rubenfeld GD et al (2014) Oxygenation response to positive end-expiratory pressure predicts mortality in acute respiratory distress syndrome. A secondary analysis of the LOVS and ExPress trials. Am J Respir Crit Care Med 190:70–76. https://doi.org/10.1164/rccm.201404-0688OC CrossRefPubMed

Taut FJ, Rippin G, Schenk P et al (2008) A Search for subgroups of patients with ARDS who may benefit from surfactant replacement therapy: a pooled analysis of five studies with recombinant surfactant protein-C surfactant (venticute). Chest 134:724–732. https://doi.org/10.1378/chest.08-0362 (Epub 2008 Aug 8) CrossRefPubMed

Willson DF, Thomas NJ, Markovitz BP, Pediatric Acute Lung Injury and Sepsis Investigators et al (2005) Effect of exogenous surfactant (calfactant) in pediatric acute lung injury: a randomized controlled trial. JAMA 293:470–476CrossRefPubMed

10.

De Luca D, Piastra M, Chidini G et al (2013) The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood: multicenter evaluation and expert consensus. Intensive Care Med 39:2083–2091. https://doi.org/10.1007/s00134-013-3110-x CrossRefPubMed

11.

Khemani RG, Smith LS, Zimmerman JJ, Erickson S, for the Pediatric Acute Lung Injury Consensus Conference Group (2015) Pediatric acute respiratory distress syndrome: definition, incidence, and epidemiology: proceedings from the pediatric acute lung injury consensus conference. Pediatr Crit Care Med 16(5 suppl 1):S23–S40CrossRefPubMed

12.

Madotto F, Pham T, Bellani G et al (2018) Resolved versus confirmed ARDS after 24 h: insights from the LUNG SAFE study. Intensive Care Med 44:564–577. https://doi.org/10.1007/s00134-018-5152-6 CrossRefPubMed

13.

Yehya N, Keim G, Thomas NJ (2018) Subtypes of pediatric acute respiratory distress syndrome have different predictors of mortality. Intensive Care Med 44(8):1230–1239CrossRefPubMed

14.

Maofeng W, Li W (2018) Use of time-varying coefficients in a cox regression model when the proportional hazard assumption is violated. Intensive Care Med. https://doi.org/10.1007/s00134-018-5351-1 CrossRef

15.

Thorpe KE, Zwarenstein M, Oxman AD et al (2009) A pragmatic—explanatory continuum indicator summary (PRECIS): a tool to help trial designers. J Clin Epidemiol 62:464–475CrossRefPubMed

16.

Peters MJ, Jones GAL, Wiley D, et al (2018) Conservative versus liberal oxygenation targets in critically ill children: the randomised multiple-centre pilot Oxy-PICU trial. Intensive Care Med 44(8):1240–1248CrossRefPubMed

Title: ‘Lumping or splitting’ in paediatric acute respiratory distress syndrome (PARDS)
Authors: Daniele De Luca
David A. Harrison
Mark J. Peters
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 9/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5323-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

‘Lumping or splitting’ in paediatric acute respiratory distress syndrome (PARDS)

Excerpt

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Excerpt

Please log in to get access to this content

Other articles of this Issue 9/2018

Correction to: Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit

The gut microbiota of critically ill patients: first steps in an unexplored world

Atrio-oesophageal fistula following atrial fibrillation ablation procedure: diagnosis with cardiac CT

Time-limited trial of intensive care treatment: an overview of current literature

Improved short- and long-term outcome of allogeneic stem cell recipients admitted to the intensive care unit: a retrospective longitudinal analysis of 942 patients

Pain distress: the negative emotion associated with procedures in ICU patients