Pathogen screening and prognostic factors in children with severe ARDS of pulmonary origin

Phung, Thuy Thi Bich; Suzuki, Tadaki; Phan, Phuc Huu; Kawachi, Shoji; Furuya, Hiroyuki; Do, Huong Thu; Kageyama, Tsutomu; Ta, Tuan Anh; Dao, Nam Huu; Nunoi, Hiroyuki; Tran, Dien Minh; Le, Hai Thanh; Nakajima, Noriko

Acute respiratory distress syndrome (ARDS) is a clinically and biologically heterogeneous syndrome with a severe lung inflammation disorder that presents as rapidly progressive hypoxemia and dyspnea. 1 ARDS is principally associated with direct injury to the lung, such as infectious pneumonia, or indirect injury to the lung resulting from systemic inflammation, such as non-pulmonary sepsis, trauma, and surgery. 2 Pneumonia remains the predominant cause of death in children under 5 years of age 3 and it is the most common trigger of ARDS in children. 4 Pediatric ARDS is one of the most lethal diseases in the pediatric intensive care unit (PICU) and is associated with a high rate of mortality. 5 Historically, pediatric ARDS was defined using the adult ARDS criteria based on the American-European Consensus Conference 6 and Berlin Definition in 2012 7 before the Pediatric Acute Lung Injury Consensus Conference published a pediatric-specific definition of ARDS in 2015. 8 According to the Berlin Definition, severe ARDS is defined as hypoxemia with ≤100 mm Hg of arterial partial pressure of oxygen (PaO 2 mm Hg) to the fraction of inspired oxygen (FIO 2 ) ratio (P/F ratio) with a positive end-expiratory pressure (PEEP)