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

01 Jan 2022
Yehya N, Khemani RG, Erickson S, Smith LS, Rowan CM, Jouvet P, Willson DF, Cheifetz IM, Ward S, Thomas NJ, Pediatric Organ Dysfunction Information Update Mandate (PODIUM) Collaborative

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.