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      Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2)

      research-article
      , MD, PhD 1 , , MD, PhD 2 , , , MBBS, MD 3 , , MD, MPH, PhD 4 , , MD, MPH 5 , , MD, MSc 6 , , MD, PhD 7 , , MD, MSCI 8 , , MD 9 , , MD 10 , , MD 11 , , MD 12 , , MD 13 , 14 , , RN, PhD, FAAN 15 , 16 , , PhD 6 , , MD, MCCM, FELSO 17 , , MBBS 18 , , MD, PhD 1 , , MD 19 , , MD 6 , , MD, PhD 20 , , MD, PhD 1 , , MD, MPH 21 , , MD, PhD, FCCM 22 , , MD, PhD, FCCM 4 , 23 , , MD, PhD 8 , 24 , , MBBS, MRCPCH, MCI 25 , , MB ChB, FRCA, FFICM 26 , , MD, MSCS 27 , , MD, PhD 28 , , PhD, BSc PT 29 , , MD, MS 30 , , MPH, RRT-NPS 31 , , MD, ChB, FRACP, FRCPC 8 , , MD, PhD 32 , , MD, PhD 6 , , MD, MBA 33 , , MD, PhD 34 , , MD, MS 35 , , MD 36 , , MD, MScr 37 , , MD, MBI 38 , , MD, MAS 39 , , MD, PhD 1 , , MD 11 , , MD 40 , , MD 41 , , MD 42 , , MD, MSc 43 , , MDCM, MPH 1 , , MD, MPH 44 , , MD 45 , , MD, MPH 21 , 46 , , MD, MSCE 30 , , MD, PhD, FCCM 40 , 47 , , MD, MsCI 8
      Pediatric Critical Care Medicine
      Lippincott Williams & Wilkins
      acute respiratory distress syndrome, best practice/evidenced-, based, guidelines, pediatric acute respiratory distress syndrome/children, pediatric critical care, systematic review

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          OBJECTIVES:

          We sought to update our 2015 work in the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PARDS), considering new evidence and topic areas that were not previously addressed.

          DESIGN:

          International consensus conference series involving 52 multidisciplinary international content experts in PARDS and four methodology experts from 15 countries, using consensus conference methodology, and implementation science.

          SETTING:

          Not applicable.

          PATIENTS:

          Patients with or at risk for PARDS.

          INTERVENTIONS:

          None.

          MEASUREMENTS AND MAIN RESULTS:

          Eleven subgroups conducted systematic or scoping reviews addressing 11 topic areas: 1) definition, incidence, and epidemiology; 2) pathobiology, severity, and risk stratification; 3) ventilatory support; 4) pulmonary-specific ancillary treatment; 5) nonpulmonary treatment; 6) monitoring; 7) noninvasive respiratory support; 8) extracorporeal support; 9) morbidity and long-term outcomes; 10) clinical informatics and data science; and 11) resource-limited settings. The search included MEDLINE, EMBASE, and CINAHL Complete (EBSCOhost) and was updated in March 2022. Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to summarize evidence and develop the recommendations, which were discussed and voted on by all PALICC-2 experts. There were 146 recommendations and statements, including: 34 recommendations for clinical practice; 112 consensus-based statements with 18 on PARDS definition, 55 on good practice, seven on policy, and 32 on research. All recommendations and statements had agreement greater than 80%.

          CONCLUSIONS:

          PALICC-2 recommendations and consensus-based statements should facilitate the implementation and adherence to the best clinical practice in patients with PARDS. These results will also inform the development of future programs of research that are crucially needed to provide stronger evidence to guide the pediatric critical care teams managing these patients.

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          Most cited references32

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          Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.

          Research electronic data capture (REDCap) is a novel workflow methodology and software solution designed for rapid development and deployment of electronic data capture tools to support clinical and translational research. We present: (1) a brief description of the REDCap metadata-driven software toolset; (2) detail concerning the capture and use of study-related metadata from scientific research teams; (3) measures of impact for REDCap; (4) details concerning a consortium network of domestic and international institutions collaborating on the project; and (5) strengths and limitations of the REDCap system. REDCap is currently supporting 286 translational research projects in a growing collaborative network including 27 active partner institutions.
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            RoB 2: a revised tool for assessing risk of bias in randomised trials

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              ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions

              Non-randomised studies of the effects of interventions are critical to many areas of healthcare evaluation, but their results may be biased. It is therefore important to understand and appraise their strengths and weaknesses. We developed ROBINS-I (“Risk Of Bias In Non-randomised Studies - of Interventions”), a new tool for evaluating risk of bias in estimates of the comparative effectiveness (harm or benefit) of interventions from studies that did not use randomisation to allocate units (individuals or clusters of individuals) to comparison groups. The tool will be particularly useful to those undertaking systematic reviews that include non-randomised studies.
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                Author and article information

                Journal
                Pediatr Crit Care Med
                Pediatr Crit Care Med
                PCC
                Pediatric Critical Care Medicine
                Lippincott Williams & Wilkins (Hagerstown, MD )
                1529-7535
                20 January 2023
                February 2023
                : 24
                : 2
                : 143-168
                Affiliations
                [1 ]Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada.
                [2 ]Pediatric Intensive Care Unit, Department of Pediatrics, Cruces University Hospital, Biocruces-Bizkaia Health Research Institute, Bizkaia, Spain.
                [3 ]Fetal and Neonatal Institute, Division of Neonatology, Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.
                [4 ]Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
                [5 ]Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN.
                [6 ]Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
                [7 ]Pediatric Intensive Care Unit, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Réanimation Pédiatrique, Lyon, France.
                [8 ]Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles. Keck School of Medicine, University of Southern California, Los Angeles, CA.
                [9 ]Department of Pediatrics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
                [10 ]Department of Pediatrics, Connecticut Children´s, Hartford, CT.
                [11 ]Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH.
                [12 ]Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh.
                [13 ]Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile.
                [14 ]Departamento de Pediatría, Unidad de Paciente Crítico Pediátrico, Facultad de Ciencias de la Vida, Hospital El Carmen de Maipú, Santiago, Chile.
                [15 ]Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA.
                [16 ]Research Institute, Children’s Hospital of Philadelphia, Philadelphia, PA.
                [17 ]Department of Pediatrics and Heart and Vascular Institute, INOVA Fairfax Medical Center, Falls Church, VA.
                [18 ]Department of Paediatric Critical Care, Perth Children’s Hospital Western Australia, Perth, WA, Australia.
                [19 ]Pediatric Intensive Care Unit, Emergency Department, Hospital General de Agudos “C. Durand” Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.
                [20 ]Division of Critical Care, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
                [21 ]Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.
                [22 ]Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
                [23 ]Departments of Pediatrics, Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.
                [24 ]Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
                [25 ]KK Women’s and Children’s Hospital, Singapore and Duke-NUS Medical School, Singapore.
                [26 ]Cardiac Critical Care and ECMO, Sidra Medicine, Doha, Qatar.
                [27 ]Department of Pediatrics, Section of Pediatric Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO.
                [28 ]Pediatric Intensive Care Unit, Hospital Universitari I Politècnic La Fe, València, Spain.
                [29 ]Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
                [30 ]Department of Anesthesiology, Critical Care and Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
                [31 ]Respiratory Therapy Department, Children’s Hospital of Philadelphia, Philadelphia, PA.
                [32 ]Immunological and Respiratory Disorders, Paediatric Critical Care Unit Research Group, Institut de Recerca Sant Joan de Déu, Pediatric Intensive Care and Intermediate Care Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
                [33 ]Department of Pediatrics, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee, WI.
                [34 ]Departement of Pediatric and Neonatal Intensive Care, Armand-Trousseau Hospital, Sorbonne University, Paris, France.
                [35 ]Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, and Departments of Anaesthesia and Pediatrics, Harvard Medical School, Boston, MA.
                [36 ]Division of Neonatology and Paediatric Intensive Care, University of Geneva, Geneva, Switzerland.
                [37 ]Department of Pediatrics, Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN.
                [38 ]Departments of Pediatrics (Critical Care) and Preventive Medicine (Health & Biomedical Informatics), Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL.
                [39 ]Division of Pediatric Critical Care, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA.
                [40 ]Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle, WA.
                [41 ]Department of Pediatrics, Division of Pediatric Critical Care, Stanford University, Palo Alto, CA.
                [42 ]Department of Intensive Care Medicine, Osaka Women’s and Children’s Hospital, Osaka, Japan.
                [43 ]Division of Pediatric Critical Care Medicine, Department of Pediatrics and Public Health Sciences, Penn State University College of Medicine, Hershey, PA.
                [44 ]Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA.
                [45 ]Department of Pediatrics, University of California San Francisco, Benioff Children’s Hospitals, San Francisco and Oakland, CA.
                [46 ]Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute Seattle, WA.
                [47 ]Harborview Medical Center, University of Washington School of Medicine, Seattle, WA.
                Author notes
                For information regarding this article, E-mail: yolandamarg.lopezfernandez@ 123456osakidetza.eus
                Article
                00008
                10.1097/PCC.0000000000003147
                9848214
                36661420
                a6e31a0d-be6d-4cbe-a9b8-818fe87fe118
                Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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                acute respiratory distress syndrome,best practice/evidenced-,based,guidelines,pediatric acute respiratory distress syndrome/children,pediatric critical care,systematic review

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