소아 급성 호흡곤란증후군에서의 Berlin 정의 = Application of the Berlin definition in children with acute respiratory distress syndrome

다국어 초록 (Multilingual Abstract)

Purpose: The revised Berlin definition (BD) showed better predictive validity for mortality in adults with acute respiratory distress syndrome (ARDS). We examined the validity of BD for pediatric ARDS as compared to the American-European Consensus Conference definition (AECCD). Methods: This single-center, retrospective study included 127 patients aged 1 month to 19 years who were admitted to the medical intensive care unit due to acute lung injury (ALI, n=31) or ARDS (n=96) using the AECCD. All patient characteristics and mortality rates were compared between the individual severity groups according to the BD and AECCD. Results: Sixty-four patients (50%) died. Mortality rates increased across the severity groups according to both definitions (26% in mild, 42% in moderate, and 75% in severe by the BD [P<0.001]; 26% in ALI non-ARDS and 58% in ARDS by the AECCD [P=0.002]). The mortality risk increased only for ‘severe ARDS’ (hazard radio for mortality, 2.56; 95% confidence intervals [CI], 1.14-5.78; P=0.023) after adjusting for confounding factors. The BD better predicted mortality, with an integrated area under the receiver operating characteristic curve (iAUC) of 0.651 (95% CI, 0.571-0.725), than the AECCD, with an iAUC of 0.584 (95% CI, 0.523-0.637). The pediatric risk of mortality (PRISM) III and pediatric index of mortality 3 scores were significantly different across BD severity groups, whereas only PRISM III scores were different according to the AECCD. Conclusion: The BD applied to children with ARDS. It could be adopted to severity classifications and predict pediatric ARDS mortality better than the AECCD. (Allergy Asthma Respir Dis 2016:4:257-263)

참고문헌 (Reference)

1 김제형, "급성호흡곤란증후군의 새로운 정의" 대한중환자의학회 28 (28): 10-16, 2013

2 De Luca D, "The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood: multicenter evaluation and expert consensus" 39 : 2083-2091, 2013

3 Phillips CR, "The Berlin definition: real change or the emperor's new clothes?" 17 : 174-, 2013

4 Bernard GR, "The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination" 149 (149): 818-824, 1994

5 Fioretto JR, "Temporal evolution of acute respiratory distress syndrome definitions" 89 : 523-530, 2013

6 Chiu LC, "Survival predictors in acute respiratory distress syndrome with extracorporeal membrane oxygenation" 99 : 243-250, 2015

7 Gemke RJ, "Scoring systems in pediatric intensive care: PRISM III versus PIM" 28 : 204-207, 2002

8 Erickson SE, "Recent trends in acute lung injury mortality: 1996-2005" 37 : 1574-1579, 2009

9 Pediatric Acute Lung Injury Consensus Conference Group, "Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference" 16 : 428-439, 2015

10 Cheifetz IM, "Pediatric acute respiratory distress syndrome" 56 : 1589-1599, 2011

11 Lopez-Fernandez Y, "Pediatric Acute Lung Injury Epidemiology and Natural History study: incidence and outcome of the acute respiratory distress syndrome in children" 40 : 3238-3245, 2012

12 Zambon M, "Mortality rates for patients with acute lung injury/ARDS have decreased over time" 133 : 1120-1127, 2008

13 Visser IH, "Mortality prediction models for pediatric intensive care: comparison of overall and subgroup specific performance" 39 : 942-950, 2013

14 Randolph AG, "Management of acute lung injury and acute respiratory distress syndrome in children" 37 : 2448-2454, 2009

15 Bone RC, "Intravascular coagulation associated with the adult respiratory distress syndrome" 61 : 585-589, 1976

16 Bindl L, "Incidence of acute respiratory distress syndrome in German children and adolescents: a population-based study" 33 : 209-312, 2005

17 Zimmerman JJ, "Incidence and outcomes of pediatric acute lung injury" 124 : 87-95, 2009

18 Wong JJ, "Epidemiology of pediatric acute respiratory distress syndrome in singapore: risk factors and predictive respiratory indices for mortality" 2 : 78-, 2014

19 Brun-Buisson C, "Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study" 30 : 51-61, 2004

20 Fröhlich S, "Definition of acute respiratory distress syndrome" 308 : 1321-1322, 2012

21 Villar J, "Current definitions of acute lung injury and the acute respiratory distress syndrome do not reflect their true severity and outcome" 25 : 930-935, 1999

22 Pepe PE, "Clinical predictors of the adult respiratory distress syndrome" 144 : 124-130, 1982

23 An C, "Assessment of preoperative magnetic resonance imaging staging in patients with hepatocellular carcinoma undergoing resection compared with the seventh American Joint Committee on Cancer System" 47 : 634-641, 2012

24 Murray JF, "An expanded definition of the adult respiratory distress syndrome" 138 : 720-723, 1988

25 Villar J, "An early PEEP/FIO2 trial identifies different degrees of lung injury in patients with acute respiratory distress syndrome" 176 : 795-804, 2007

26 Hernu R, "An attempt to validate the modification of the American-European consensus definition of acute lung injury/acute respiratory distress syndrome by the Berlin definition in a university hospital" 39 : 2161-2170, 2013

27 Fowler AA, "Adult respiratory distress syndrome: risk with common predispositions" 98 (98): 593-597, 1983

28 ARDS Definition Task Force, "Acute respiratory distress syndrome: the Berlin Definition" 307 : 2526-2533, 2012

29 Kneyber MC, "Acute respiratory distress syndrome: is it underrecognized in the pediatric intensive care unit?" 34 : 751-754, 2008

30 Monahan LJ, "Acute respiratory distress syndrome" 43 : 278-284, 2013

31 Ashbaugh DG, "Acute respiratory distress in adults" 2 : 319-323, 1967

32 Erickson S, "Acute lung injury in pediatric intensive care in Australia and New Zealand: a prospective, multicenter, observational study" 8 : 317-323, 2007