Abstract：
Diagnosis of pediatric acute respiratory distress syndrome (PARDS) in resource-limited settings (RLS) is challenging and remains poorly described. We conducted a review of the literature to optimize recognition of PARDS in RLS and to provide recommendations/statements for clinical practice and future research in these settings as part of the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2).
MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost).
We included studies related to precipitating factors for PARDS, mechanical ventilation (MV), pulmonary and nonpulmonary ancillary treatments, and long-term outcomes in children who survive PARDS in RLS.
Title/abstract review, full-text review, and data extraction using a standardized data collection form.
The Grading of Recommendations Assessment, Development, and Evaluation approach was used to identify and summarize evidence and develop recommendations. Seventy-seven studies were identified for full-text extraction. We were unable to identify any literature on which to base recommendations. We gained consensus on six clinical statements (good practice, definition, and policy) and five research statements. Clinicians should be aware of diseases and comorbidities, uncommon in most high-income settings, that predispose to the development of PARDS in RLS. Because of difficulties in recognizing PARDS and to avoid underdiagnosis, the PALICC-2 possible PARDS definition allows exclusion of imaging criteria when all other criteria are met, including noninvasive metrics of hypoxemia. The availability of MV support, regular MV training and education, as well as accessibility and costs of pulmonary and nonpulmonary ancillary therapies are other concerns related to management of PARDS in RLS. Data on long-term outcomes and feasibility of follow-up in PARDS survivors from RLS are also lacking.
To date, PARDS remains poorly described in RLS. Clinicians working in these settings should be aware of common precipitating factors for PARDS in their patients. Future studies utilizing the PALICC-2 definitions are urgently needed to describe the epidemiology, management, and outcomes of PARDS in RLS.
MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost).
We included studies related to precipitating factors for PARDS, mechanical ventilation (MV), pulmonary and nonpulmonary ancillary treatments, and long-term outcomes in children who survive PARDS in RLS.
Title/abstract review, full-text review, and data extraction using a standardized data collection form.
The Grading of Recommendations Assessment, Development, and Evaluation approach was used to identify and summarize evidence and develop recommendations. Seventy-seven studies were identified for full-text extraction. We were unable to identify any literature on which to base recommendations. We gained consensus on six clinical statements (good practice, definition, and policy) and five research statements. Clinicians should be aware of diseases and comorbidities, uncommon in most high-income settings, that predispose to the development of PARDS in RLS. Because of difficulties in recognizing PARDS and to avoid underdiagnosis, the PALICC-2 possible PARDS definition allows exclusion of imaging criteria when all other criteria are met, including noninvasive metrics of hypoxemia. The availability of MV support, regular MV training and education, as well as accessibility and costs of pulmonary and nonpulmonary ancillary therapies are other concerns related to management of PARDS in RLS. Data on long-term outcomes and feasibility of follow-up in PARDS survivors from RLS are also lacking.
To date, PARDS remains poorly described in RLS. Clinicians working in these settings should be aware of common precipitating factors for PARDS in their patients. Future studies utilizing the PALICC-2 definitions are urgently needed to describe the epidemiology, management, and outcomes of PARDS in RLS.
摘要：
目的：资源有限环境（RLS）中小儿急性呼吸窘迫综合征（PARDS）的诊断具有挑战性，并且描述不充分。作为第二届小儿急性肺损伤共识会议（PALICC-2）的一部分，我们对文献进行了综述，以优化对RLS中PARDS的识别，并为这些环境中的临床实践和未来研究提供建议/声明。
方法：MEDLINE(Ovid)，Embase(Elsevier),和CINAHL完成（EBSCOhost）。
方法：我们纳入了与PARDS的诱发因素相关的研究，机械通气(MV),肺和非肺辅助治疗，以及在RLS中存活PARDS的儿童的长期结局。
方法：标题/摘要评论，全文回顾,和使用标准化的数据收集表格进行数据提取。
结果：建议评估的分级，发展,采用评估方法进行证据识别和总结，并提出建议。确定了77项研究用于全文提取。我们无法确定任何文献作为推荐的基础。我们在六项临床声明(良好做法，定义,和政策)和五项研究声明。临床医生应该意识到疾病和合并症，在大多数高收入环境中并不常见，容易在RLS中发展PARDS。由于难以识别PARDS和避免诊断不足，PALICC-2可能的PARDS定义允许在满足所有其他标准时排除成像标准,包括低氧血症的非侵入性指标。MV支持的可用性，定期MV培训和教育，以及肺和非肺辅助治疗的可及性和费用是与RLS中PARDS管理相关的其他问题.也缺乏来自RLS的PARDS幸存者的长期结果和随访可行性的数据。
结论：迄今为止，PARDS在RLS中的描述仍然很差。在这些环境中工作的临床医生应该意识到患者PARDS的常见诱发因素。未来的研究迫切需要利用PALICC-2定义来描述流行病学，管理,以及RLS中PARDS的结果。
方法：MEDLINE(Ovid)，Embase(Elsevier),和CINAHL完成（EBSCOhost）。
方法：我们纳入了与PARDS的诱发因素相关的研究，机械通气(MV),肺和非肺辅助治疗，以及在RLS中存活PARDS的儿童的长期结局。
方法：标题/摘要评论，全文回顾,和使用标准化的数据收集表格进行数据提取。
结果：建议评估的分级，发展,采用评估方法进行证据识别和总结，并提出建议。确定了77项研究用于全文提取。我们无法确定任何文献作为推荐的基础。我们在六项临床声明(良好做法，定义,和政策)和五项研究声明。临床医生应该意识到疾病和合并症，在大多数高收入环境中并不常见，容易在RLS中发展PARDS。由于难以识别PARDS和避免诊断不足，PALICC-2可能的PARDS定义允许在满足所有其他标准时排除成像标准,包括低氧血症的非侵入性指标。MV支持的可用性，定期MV培训和教育，以及肺和非肺辅助治疗的可及性和费用是与RLS中PARDS管理相关的其他问题.也缺乏来自RLS的PARDS幸存者的长期结果和随访可行性的数据。
结论：迄今为止，PARDS在RLS中的描述仍然很差。在这些环境中工作的临床医生应该意识到患者PARDS的常见诱发因素。未来的研究迫切需要利用PALICC-2定义来描述流行病学，管理,以及RLS中PARDS的结果。
