The Pediatric Acute Lung Injury Consensus Conference “at-risk for pediatric acute respiratory distress syndrome” criteria identify critically ill children at high risk of pediatric acute respiratory distress syndrome and poor outcomes.

Interventional trials aimed at pediatric acute respiratory distress syndrome prevention should target patients early in their illness course and include patients on high-flow oxygen and positive pressure ventilation.

We evaluated the frequency of children at risk for pediatric acute respiratory distress syndrome and rate of subsequent pediatric acute respiratory distress syndrome diagnosis and used multivariable logistic regression to identify factors associated with subsequent pediatric acute respiratory distress syndrome.

Frequency of at risk for pediatric acute respiratory distress syndrome was 3.8% among the 8,122 critically ill children who were screened and 5.8% among the 5,334 screened children on positive pressure ventilation or high-flow oxygen. Among the 310 at-risk children, median age was 2.1 years.

Sixty-six children (21.3%) were subsequently diagnosed with pediatric acute respiratory distress syndrome, a median of 22.6 hours later.

Subsequent pediatric acute respiratory distress syndrome was associated with increased mortality and longer durations of invasive ventilation and PICU care.

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