A 5-year-old on mechanical ventilation for ARDS has worsening hypoxemia despite FiO2 0.8. ABG shows PaO2 52 mmHg. The pediatric intensivist calculates the oxygenation index (OI). Which OI value meets the definition for SEVERE pediatric ARDS (per PALICC 2015)?

• A OI ≥ 4
• B OI ≥ 8
• C OI ≥ 16 AND P/F ratio < 100
• D OI ≥ 16 ✓

Explanation

The Pediatric Acute Lung Injury Consensus Conference (PALICC 2015) classifies pediatric ARDS by oxygenation index (OI = [FiO2 × Mean Airway Pressure × 100] / PaO2): Mild = OI 4–7.9; Moderate = OI 8–15.9; Severe = OI ≥ 16. This replaces the adult P/F ratio in invasively ventilated children, as mean airway pressure is a key determinant of oxygenation support. An OI ≥ 16 indicates severe PARDS with high mortality risk and need for adjunct therapies like prone positioning and high-frequency oscillatory ventilation.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.