Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2)
Authors: Emeriaud Guillaume , López-Fernández Yolanda M. , Iyer Narayan Prabhu , Bembea Melania M. , Agulnik Asya , Barbaro Ryan P. , Baudin Florent , Bhalla Anoopindar , Brunow de Carvalho Werther , Carroll Christopher L. , Cheifetz Ira M. , Chisti Mohammod J. , Cruces Pablo , Curley Martha A. Q. , Dahmer Mary K. , Dalton Heidi J. , Erickson Simon J. , Essouri Sandrine , Fernández Analía , Flori Heidi R. , Grunwell Jocelyn R. , Jouvet Philippe , Killien Elizabeth Y. , Kneyber Martin C. J. , Kudchadkar Sapna R. , Korang Steven Kwasi , Lee Jan Hau , Macrae Duncan J. , Maddux Aline , Modesto i Alapont Vicent , Morrow Brenda M. , Nadkarni Vinay M. , Napolitano Natalie , Newth Christopher J. L. , Pons-Odena Martí , Quasney Michael W. , Rajapreyar Prakadeshwari , Rambaud Jerome , Randolph Adrienne G. , Rimensberger Peter , Rowan Courtney M. , Sanchez-Pinto L. Nelson , Sapru Anil , Sauthier Michael , Shein Steve L. , Smith Lincoln S. , Steffen Katerine , Takeuchi Muneyuki , Thomas Neal J. , Tse Sze Man , Valentine Stacey , Ward Shan , Watson R. Scott , Yehya Nadir , Zimmerman Jerry J. , Khemani Robinder G. ,   on behalf of the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) Group on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: January 2023

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.