Acute respiratory distress syndrome:: is it underrecognized in the pediatric intensive care unit?

Objective: To describe the incidence of acute respiratory distress syndrome (ARDS) in mechanically ventilated children and to study whether ARDS is underrecognized in this patient population. Design and setting: Retrospective observational study in a single-center bed pediatric intensive care unit serving two Dutch provinces. Patients: 533 mechanically ventilated children aged 0-16 years, all of whom met the North-American European Consensus Conference criteria for ARDS. Measurements and results: Chest radiographs were screened for the novel presence of bilateral infiltrates, in patients with bilateral infiltrates the PaO2/FIO2 ratio was calculated on two separate consecutive measurements. If below 200, the patient was classified as having ARDS. Left ventricular dysfunction was ruled out by echocardiography. The incidence was calculated by obtaining the number of children aged 0-16 years in our region. For each patient it was noted whether the patient was currently considered to have ARDS. Forty-one patients (7.7%) met the criteria for ARDS, with an incidence of 2.2 per 100,000 per year. The mortality rate was 20.4%. Thirty patients (73.1%) had primary ARDS, mainly from viral lower respiratory tract disease. Only ten patients (24.4%) currently had ARDS. Conclusions: The incidence of pediatric ARDS is low compared to that of adult ARDS, and further underestimated as most patients were diagnosed by their underlying diseases.