Knowledge and practices of Brazilian pediatric intensivists of PALICC-2 definitions and management of pediatric acute respiratory distress syndrome.

OBJECTIVE: To evaluate the knowledge and clinical practices of pediatric intensivists in Brazil regarding the Pediatric Acute Lung Injury Consensus Conference 2 (PALICC-2) definitions and management of pediatric acute respiratory distress syndrome. METHODS: A nationwide online survey was conducted between February and August 2025 among pediatric intensive care unit physicians. The questionnaire assessed demographics, training, knowledge of the PALICC-2 diagnostic criteria, and preferred management strategies in response to a case vignette. Responses were analyzed descriptively. RESULTS: A total of 212 intensivists participated, of whom 158 completed the survey. Most respondents were female (67%), aged 31 - 40 years (50%), and had been out of school for 11 - 20 years (39%). The majority completed both general pediatrics and pediatric intensive care residency training (70%). For ventilatory management, 48.5% used a tidal volume of 4 - 6mL/kg, while 46.3% used 6 - 8mL/kg; 81% selected titration of optimal positive end-expiratory pressure; only 39% used a protective plateau pressure; 71.3% used a driving pressure limited to 15cmH2O. Analgesia strategies most frequently included neuromuscular blockade optimization (85%). In a case vignette, 88.8% correctly recognized severe pediatric acute respiratory distress syndrome according to PALICC-2 criteria, and nearly all (98.9%) classified the case as severe. In the event of deterioration despite optimized conventional therapies, 87% indicated extracorporeal membrane oxygenation as their rescue strategy. CONCLUSION: Brazilian pediatric intensivists demonstrated fair knowledge of PALICC-2 definitions, though they had some concerns about recognizing pediatric acute respiratory distress syndrome. Variability in management strategies underscores the need for continued dissemination of standardized guidelines and training to improve adherence and optimize outcomes.