Respiratory Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

Nadir Yehya, Robinder G. Khemani, Simon Erickson, Lincoln S. Smith, Courtney M. Rowan, Philippe Jouvet, Doug F. Willson, Ira M. Cheifetz, Shan Ward, Neal J. Thomas, Marie E Steiner

Research output: Contribution to journalReview articlepeer-review

Abstract

CONTEXT: Respiratory dysfunction is a component of every organ failure scoring system developed, reflecting the significance of the lung in multiple organ dysfunction syndrome. However, existing systems do not reflect current practice and are not consistently evidence based. OBJECTIVE: We aimed to review the literature to identify the components of respiratory failure associated with outcomes in children, with the purpose of developing an operational and evidence-based definition of respiratory dysfunction. DATA SOURCES: Electronic searches of PubMed and Embase were conducted from 1992 to January 2020 by using a combination of medical subject heading terms and text words to define respiratory dysfunction, critical illness, and outcomes. STUDY SELECTION: We included studies of critically ill children with respiratory dysfunction that evaluated the performance of metrics of respiratory dysfunction and their association with patient-centered outcomes. Studies in adults, studies in premature infants (≤36 weeks' gestational age), animal studies, reviews and commentaries, case series with sample sizes ≤10, and studies not published in English in which we were unable to determine eligibility criteria were excluded. DATA EXTRACTION: Data were abstracted into a standard data extraction form. RESULTS: We provided binary (no or yes) and graded (no, nonsevere, or severe) definitions of respiratory dysfunction, prioritizing oxygenation and respiratory support. The proposed criteria were approved by 82% of members in the first round, with a score of 8 of 9 (interquartile range 7-8). LIMITATIONS: Exclusion of non-English publications, heterogeneity across the pediatric age range, small sample sizes, and incomplete handling of confounders are limitations. CONCLUSIONS: We propose definitions for respiratory dysfunction in critically ill children after an exhaustive literature review.

Original languageEnglish (US)
Pages (from-to)S48-S52
JournalPediatrics
Volume149
Issue numberSupplement_1
DOIs
StatePublished - Jan 1 2022

Bibliographical note

Funding Information:
FUNDING: Funded by grant NIH K23-HL136688 (Dr Yehya), and award from the Fonds de Recherche du Quebec Santé(Dr Jouvet), grant NIH UH3-HL141736 (Dr Cheifetz), and grant NIH K12-HD047349 (Dr Ward). The Russell Raphaely Endowed Chair for Critical Care Medicine at the Children’s Hospital of Philadelphia contributed to funding for publication costs for this article. No funding body had any role in the design and conduct of this review. Funded by the National Institutes of Health (NIH).

Funding Information:
Funded by grant NIH K23-HL136688 (Dr Yehya), and award from the Fonds de Recherche du Quebec Santé (Dr Jouvet), grant NIH UH3-HL141736 (Dr Cheifetz), and grant NIH K12-HD047349 (Dr Ward). The Russell Raphaely Endowed Chair for Critical Care Medicine at the Children's Hospital of Philadelphia contributed to funding for publication costs for this article. No funding body had any role in the design and conduct of this review. Funded by the National Institutes of Health (NIH).

Publisher Copyright:
Copyright © 2021 by the American Academy of Pediatrics

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