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

Guillaume Emeriaud, Yolanda M. López-Fernández, Narayan Prabhu Iyer, Melania M. Bembea, Asya Agulnik, Ryan P. Barbaro, Florent Baudin, Anoopindar Bhalla, Werther Brunow De Carvalho, Christopher L. Carroll, Ira M. Cheifetz, Mohammod J. Chisti, Pablo Cruces, Martha A.Q. Curley, Mary K. Dahmer, Heidi J. Dalton, Simon J. Erickson, Sandrine Essouri, Analía Fernández, Heidi R. FloriJocelyn R. Grunwell, Philippe Jouvet, Elizabeth Y. Killien, Martin C.J. Kneyber, Sapna R. Kudchadkar, Steven Kwasi Korang, Jan Hau Lee, Duncan J. Macrae, Aline Maddux, Vicent Modesto I Alapont, Brenda M. Morrow, Vinay M. Nadkarni, Natalie Napolitano, Christopher J.L. Newth, Martí Pons-Odena, Michael W. Quasney, Prakadeshwari Rajapreyar, Jerome Rambaud, Adrienne G. Randolph, Peter Rimensberger, Courtney M. Rowan, L. Nelson Sanchez-Pinto, Anil Sapru, Michael Sauthier, Steve L. Shein, Lincoln S. Smith, Katerine Steffen, Muneyuki Takeuchi, Neal J. Thomas, Sze Man Tse, Stacey Valentine, Shan Ward, R. Scott Watson, Nadir Yehya, Jerry J. Zimmerman, Robinder G. Khemani

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)143-168
Number of pages26
JournalPediatric Critical Care Medicine
Issue number2
StatePublished - Feb 1 2023


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

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Pediatrics, Perinatology, and Child Health


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