• Brenda M Morrow, Eleonora Lozano Ray, Mignon McCulloch, Shamiel Salie, Asma Salloo, Ilse N Appel, Elri Du Plooy, Shannon Cawood, Porai Moshesh, Kathryn H Keeling, Lincoln J Solomon, Sbekezelo Hlophe, Despina Demopoulos, Noor Parker, Ayesha Bibi Khan, Kuban D Naidoo, and Andrew C Argent.
• Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
• Pediatr Crit Care Me. 2023 Dec 1; 24 (12): 106310711063-1071.

ObjectivesTo describe the prevalence of pediatric acute respiratory distress syndrome (pARDS) and the characteristics of children with pARDS in South African PICUs.DesignObservational multicenter, cross-sectional point-prevalence study.SettingEight PICUs in four South African provinces.PatientsAll children beyond the neonatal period and under 18 years of age admitted to participating PICUs.InterventionsNone.Measurements And Main ResultsClinical and demographic data were prospectively collected on a single day of each month, from February to July 2022, using a centralized database. Cases with or at risk of pARDS were identified using the 2015 Pediatric Acute Lung Injury Consensus Conference criteria. Prevalence was calculated as the number of children meeting pARDS criteria/the total number of children admitted to PICU at the same time points. Three hundred ten patients were present in the PICU on study days: 166 (53.5%) male, median (interquartile range [IQR]) age 9.8 (3.1-32.9) months, and 195 (62.9%) invasively mechanically ventilated. Seventy-one (22.9%) patients were classified as being "at risk" of pARDS and 95 patients (prevalence 30.6%; 95% CI, 24.7-37.5%) fulfilled pARDS case criteria, with severity classified as mild (58.2%), moderate (25.3%), and severe (17.6%). Median (IQR) admission Pediatric Index of Mortality 3 risk of mortality in patients with and without pARDS was 5.6 (3.4-12.1) % versus 3.9 (1.0-8.2) % ( p = 0.002). Diagnostic categories differed between pARDS and non-pARDS groups ( p = 0.002), with no difference in age, sex, or presence of comorbidities. On multivariable logistic regression, increasing admission risk of mortality (adjusted odds ratio [aOR] 1.02; 95% CI, 1.00-1.04; p = 0.04) and being admitted with a respiratory condition (aOR 2.64; 95% CI, 1.27-5.48; p = 0.01) were independently associated with an increased likelihood of having pARDS.ConclusionsThe 30.6% prevalence of pARDS in South Africa is substantially higher than reports from other sociogeographical regions, highlighting the need for further research in this setting.Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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