title: Epidemiology and outcomes of acute respiratory distress syndrome in children according to the Berlin definition: a multicenter prospective study.
abstract: OBJECTIVE
  In 2012, a new acute respiratory distress syndrome definition was proposed for adult patients. It was later validated for infants and toddlers. Our objective was to evaluate the prevalence, outcomes, and risk factors associated with acute respiratory distress syndrome in children up to 15 years according to the Berlin definition.
  
  
  METHODS
  A prospective, multicenter observational study from March to September 2013.
  
  
  METHODS
  Seventy-seven PICU beds in eight centers: two private hospitals and six public academic hospitals in Brazil.
  
  
  METHODS
  All children aged 1 month to 15 years admitted to the participating PICUs in the study period.
  
  
  METHODS
  None.
  
  
  RESULTS
  All children admitted to the PICUs were daily evaluated for the presence of acute respiratory distress syndrome according to the American-European Consensus Conference and Berlin definitions. Of the 562 patients included, acute respiratory distress syndrome developed in 57 patients (10%) and 58 patients (10.3%) according to the Berlin definition and the American-European Consensus Conference definition, respectively. Among patients with acute respiratory distress syndrome according to the Berlin definition, nine patients (16%) were mild, 21 (37%) were moderate, and 27 (47%) were severe. Compared with patients without acute respiratory distress syndrome, patients with acute respiratory distress syndrome had significantly higher severity scores, longer PICU and hospital length of stay, longer duration of mechanical ventilation, and higher mortality (p < 0.001). The presence of two or more comorbidities and admission for medical reasons were associated with development of acute respiratory distress syndrome. Comparisons across the three the Berlin categories showed significant differences in the number of ventilator-free days (21, 20, and 5 d, p = 0.001) and mortality for severe acute respiratory distress syndrome (41%) in comparison with mild (0) and moderate (15%) acute respiratory distress syndrome(p = 0.02). No differences in PICU or hospital stay were observed across the groups.
  
  
  CONCLUSIONS
  The Berlin definition can identify a subgroup of patients with distinctly worse outcomes, as shown by the increased mortality and reduced number of ventilator-free days in pediatric patients with severe acute respiratory distress syndrome.
authors: 1Pediatrics Division, Hospital Universitário da Universidade de São Paulo, Sao Paulo, Brazil. 2Emergency Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil. 3Department of Pediatrics, Instituto da Criança do Hospital das Clínicas da Universidade de São Paulo, Sao Paulo, Brazil. 4Radiology Division, Hospital Universitário da Universidade de São Paulo, Sao Paulo, Brazil. 5Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicinada Universidade de São Paulo, Sao Paulo, Brazil. 6Division of Biostatistics, Keck School of Medicine, Preventive Medicine, University of Southern California, Los Angeles, CA. 7Clinical Trials and Pharmacovigilance Division, Instituto Butantan, Sao Paulo, Brazil.
authors: Eliane R
authors: ER
authors: Barreira
authors: Gabriela O C
authors: GO
authors: Munoz
authors: Priscilla O
authors: PO
authors: Cavalheiro
authors: Adriana S
authors: AS
authors: Suzuki
authors: Natalia V
authors: NV
authors: Degaspare
authors: Huei H
authors: HH
authors: Shieh
authors: João A D S
authors: JA
authors: Martines
authors: Juliana C
authors: JC
authors: Ferreira
authors: Christianne
authors: C
authors: Lane
authors: Werther B
authors: WB
authors: Carvalho
authors: Alfredo E
authors: AE
authors: Gilio
authors: Alexander R
authors: AR
authors: Precioso
mesh_terms: D000293:Adolescent; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000401:mortality / Q000706:statistics & numerical data*; D012128:Respiratory Distress Syndrome / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D012720:Severity of Illness Index