The authors found very interesting and important results. Applying AECC, 36 children were classified as ALI and 185 as ARDS, with

mortality rates of 13.9% and 17.8%, respectively. Conversely, 36 were classified as mild, 97 as moderate, and 88 as severe ARDS when applying the BD. The BD described the clinical situation better than AECC, with similar results published in adults. Also, the main outcomes were significantly different only for severe ARDS; mortality was 13.9% for mild ARDS, 11.3% for moderate ARDS, and 25% for severe ARDS. They did not find significant differences between mild and moderate classes. However, the inclusion of a severe category in the BD helped to increase its validity. Despite not aimed at identifying risk factors and their association DZNeP cost with ARDS, some were presented (sepsis, near‐drowning, congenital immunodeficiencies, thoracic trauma, etc.). As expected, they are different than those in the adult population. A properly designed study is therefore

necessary to address this issue. The authors concluded that the new ARDS definition correctly adjusts and is able to define the syndrome in its population, subdividing it into ABT 263 mild/moderate and severe ARDS. Some limitations were addressed. Firstly, the number of patients included was not large. This is a difficulty in all pediatric studies, as populations of children in intensive care are much smaller than those of adults. Secondly, clinical data was not correlated with lung morphology. However, lung biopsy is not commonly performed in critically ill children. The Brazilian Pediatric ARDS Study Group6 performed a prospective, multicentre cohort study from March to September of 2013, which aimed: (1) to evaluate the prevalence of ARDS; (2) to determine risk factors for ARDS; and (3) to evaluate whether the use of BD in critically Edoxaban ill children can better discriminate the severity of the disease compared with the AECC definition. The distribution and outcomes

of the patients according to the AECC and BD are shown in Table 1. The BD better discriminates the severity of ARDS in children when compared to the AECC definition, as shown by the incremental increase in mortality rates and reduced number of ventilation‐free days in patients with severe ARDS. In summary, we congratulate De Luca et al.2 for their timely study, and thank them for their comments. From now on, the pediatric community involved in critical care and emergency medicine, of which we are members, has specific parameters to compare when studying such a serious disease as ARDS in children. Moreover, we look forward to the authors taking a similar initiative in Latin America and other future projects. The authors declare no conflicts of interest.