International collaborative research for pediatric and neonatal lung injury: the example of an ESPNIC initiative to validate definitions and formulate future research questions.

An interesting review of acute respiratory distress (ARDS) definitions has been recently published in the Jornal de Pediatria, focusing on actual needs in terms of research and clinical care of pediatric ARDS.1 Unfortunately, timing prevented the consideration of an important step forward in this field. The European Society for Pediatric and Neonatal Intensive Care (ESPNIC), together with some members of the original ARDS Task Force, have set up an international collaborative project to validate the new Berlin definition for infants and toddlers.2 This project is the first initiative linking different pediatric intensive care units (PICU) in order to reach enough statistical power to address a specific research need. Figure 1 shows the ESPNIC net for this project. Indeed, as Fioretto et al. summarized,1 no specific pediatric validation had ever been conducted, even though some children were included in the original ARDS definition proposed by Ashbaugh et al. in 1967.3 Fioretto et al. described several possible limitations of the Berlin definition: however, some of the points raised by these authors should not be considered as a limitation, since the new Berlin definition is not supposed to be a predictive tool, but rather a framework to define a syndrome for epidemiology, clinical care, and research.