The authors reply: What Will Be the Consensus of Pediatric Intensivists Regarding the Diagnosis of Pediatric Acute Respiratory Distress Syndrome?

摘要

We thank Munoz et al (1) for their letter discussing the recently published recommendations and definitions of pediatric acute respiratory distress syndrome (PARDS) from the Pediatric Acute Lung Injury Consensus Conference (PALICC) (2). We are pleased they consider the recommendations "breakthrough" but hope that clinicians will proceed with caution until external validation is completed. These recommendations, which were created to better assess and manage PARDS in children, are considered the groundwork for which further research is essential. The authors questioned the use of oxygenation index (01) in the PARDS definition. The 01 values used to define severity of PARDS were derived based on analyses of data from 397 children previously collected data from Children's Hospital of Los Angeles (3) and the Pediatric Study Group, Australian and New Zealand Intensive Care Society (4), and then validated with data from 692 children collected from an additional datasets from other members of the PALICC members (5-9), as described in a supplemental article (10). Support for the relationship of 01 to outcome in PARDS is also supplied by an independent dataset reported by Yehya et al (11) from Children's Hospital of Philadelphia, Additional external validation would clearly be helpful, however, as would data identifying the day or time after the initial injury for which calculation of OI would be most predictive of outcome.