SPECIAL ARTICLEOPENExecutive Summary of the SecondInternational Guidelines for the Diagnosis andManagement of Pediatric Acute RespiratoryDistress Syndrome (PALICC-2)Guillaume Emeriaud,MD,PhDOBJECTIVES:We sought to update our 2015 work in the Second PediatricYolanda M.Lopez-Fernandez,Acute Lung Injury Consensus Conference (PALICC-2)guidelines for the diag-MD,PhD2nosis and management of pediatric acute respiratory distress syndrome(PARDS),considering new evidence and topic areas that were not previously addressed.Narayan Prabhu lyer,MBBS,MD3Melania M.Bembea,MD,MPH,DESIGN:International consensus conference series involving 52 multidiscipli-PhD+nary international content experts in PARDS and four methodology experts fromAsya Agulnik,MD,MPH515 countries,using consensus conference methodology,and implementationscienceRyan P.Barbaro,MD,MScsFlorent Baudin,MD,PhD7SETTING:Not applicable.Anoopindar Bhalla,MD,MSCIPATIENTS:Patients with or at risk for PARDS.Werther,Brunow de CarvalhoINTERVENTIONS:None.MDChristopher L.Carroll,MD10MEASUREMENTS AND MAIN RESULTS:Eleven subgroups conducted sys-tematic or scoping reviews addressing 11 topic areas:1)definition,incidence,Ira M.Cheifetz,MD'1and epidemiology;2)pathobiology,severity,and risk stratification;3)ventilatoryMohammod J.Chisti,MD12support;4)pulmonary-specific ancillary treatment;5)nonpulmonary treatment;Pablo,Cruces MD13146)monitoring;7)noninvasive respiratory support;8)extracorporeal support;9)Martha A.Q.Curley,RN,PhD,morbidity and long-term outcomes;10)clinical informatics and data science;andFAAN15.1611)resource-limited settings.The search included MEDLINE,EMBASE,andMary K.Dahmer,PhDsCINAHL Complete (EBSCOhost)and was updated in March 2022.GradingHeidi J.Dalton,MD,MCCM,of Recommendations,Assessment,Development,and Evaluation methodologyFELSOTwas used to summarize evidence and develop the recommendations,which werediscussed and voted on by all PALICC-2 experts.There were 146 recommenda-tions and statements,including:34 recommendations for clinical practice;112consensus-based statements with 18 on PARDS definition,55 on good practice,seven on policy,and 32 on research.All recommendations and statements hadCopyright 2023 The Author(s).Published by Wolters Kluwer Health,agreement greater than 80%.Inc.on behalf of the Society ofCONCLUSIONS:PALICC-2 recommendations and consensus-based state-Critical Care Medicine and the Worldments should facilitate the implementation and adherence to the best clinicalFederation of Pediatric Intensivepractice in patients with PARDS.These results will also inform the developmentand Critical Care Societies.Thisof future programs of research that are crucially needed to provide stronger evi-is an open-access article dis-dence to guide the pediatric critical care teams managing these patients.tributed under the terms of theCreative Commons Attribution-NonKEY WORDS:acute respiratory distress syndrome;best practice/evidenced-Commercial-No Derivatives Licensebased;guidelines;pediatric a
