Age \>37 weeks corrected gestational age to 21 years, including adults lacking the capacity to consent.
Within 72 hours of the start of invasive mechanical ventilation and meet the criteria for pediatric ARDS (new infiltrate on chest imaging and a known ARDS risk factor within 7 days of the onset of hypoxemia) and either meet criteria for moderate or severe pediatric ARDS between 4-72 hours of IMV (OI ≥ 8 or OSI ≥ 7.5) OR have an OI ≥ 20 or an OSI ≥ 14 x 15 minutes between 0-4 hours of IMV.
Subgroup of children eligible for longituduinal Blood Collection: Children with severe PARDS (OI ≥ 16 or an OSI ≥ 12 between 4-72 hours of IMV) or those with an OI ≥ 20 or an OSI ≥ 14 for 15 minutes between 0-4 hours of IMV will be eligible for collection of longitudinal plasma samples.
You may not be if
Non-conventional invasive mechanical ventilation (i.e. High Frequency Oscillatory Ventilation, Airway Pressure Release Ventilation) at the time of ICU admission
ECMO or iNO (or other inhaled pulmonary vasodilator therapy) at the time of ICU admission
Significant lower airways obstruction (examination of ventilator and capnography waveforms by site study or medical team)
Air leak \>20% (endotracheal tube, tracheostomy tube, or thoracostomy tube)
Home Invasive Mechanical Ventilation
Cyanotic Congenital Heart Disease
Previous enrollment in the DiNO study
Do not resuscitate order at the time of pediatric ARDS diagnosis.
Blood gas not obtained prior to initiation of ECMO, iNO, or non-conventional ventilation.
