Progressive Acute Respiratory Distress Syndrome (ARDS) when Children Contract COVID-19

Based on Section 3.5.1 Subsection 3.5 Item III Guidelines for Diagnosis and Treatment of COVID-19 in Children (Enclosed with Decision No. 5155/QD-BYT of 2021) stipulating **** severe complications of the disease related to acute respiratory distress syndrome (ARDS) as follows:

* Diagnostic Criteria for ARDS

- Onset: new or worsening respiratory symptoms within one week from the onset of clinical symptoms.

- X-ray, chest CT scan, or lung ultrasound: bilateral opacities not fully explained by pleural effusion, lobar collapse, or lung nodules.

- The origin of pulmonary edema not fully explained by cardiac failure or fluid overload. Objective assessment (echocardiography) is needed to exclude hydrostatic edema if risk factors are not evident.

- Hypoxemia: in children, based on the oxygenation index (OI* = MAP × FiO₂ × 100/PaO₂) (MAP: mean airway pressure) or the oxygenation saturation index (OSI = MAP × FiO₂ × 100/SpO₂) for patients on invasive mechanical ventilation, and PaO₂/FiO₂ or SpO₂/FiO₂ for those on CPAP or non-invasive ventilation (NIV):

+ NIV BiLevel or CPAP ≥ 5 cmH₂O via mask: PaO₂/FiO₂ ≤ 300 mmHg or SpO₂/FiO₂ ≤ 264

+ Mild ARDS (invasive mechanical ventilation): 4 ≤ OI < 8 or 5 ≤ OSI < 7.5

+ Moderate ARDS (invasive mechanical ventilation): 8 ≤ OI < 16 or 7.5 ≤ OSI < 12.3

+ Severe ARDS (invasive mechanical ventilation): OI ≥ 16 or OSI ≥ 12.3

Note: clinically suspect ARDS when using oxygen masks or non-invasive ventilation (NCPAP/HFNC) with FiO₂ **** > 40% to maintain SpO ₂ **** 88-97%.

Sincerely!