Paediatrics: how to manage acute respiratory distress syndrome

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Abstract

Background: Acute respiratory distress syndrome (ARDS) is a significant cause of mortality and morbidity amongst critically ill children. The purpose of this narrative review is to provide an up-to-date review on the evaluation and management of paediatric ARDS (PARDS).

Methods: A PubMed search was performed with Clinical Queries using the key term “acute respiratory distress syndrome”. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. Google, Wikipedia and UpToDate were also searched to enrich the review. The search was restricted to the English literature and children.

Discussion: Non-invasive positive pressure ventilation, lung-protective ventilation strategies, conservative fluid management and adequate nutritional support all have proven efficacy in the management of PARDS. The Pediatric Acute Lung Injury Consensus Conference recommends the use of corticosteroids, high-frequency oscillation ventilation and inhaled nitric oxide in selected scenarios. Partial liquid ventilation and surfactant are not considered efficacious based on evidence from clinical trials.

Conclusion: PARDS is a serious but relatively rare cause of admission into the paediatric intensive care unit and is associated with high mortality. Non-invasive positive pressure ventilation, lung-protective ventilation strategies, conservative fluid management and adequate nutrition are advocated. As there has been a lack of progress in the management of PARDS in recent years, further well-designed, large-scale, randomized controlled trials in this field are urgently needed.

Keywords: acute lung injury, critical care, paediatric acute respiratory distress syndrome, respiratory failure, therapy.

Citation: Hon KL, Leung KKY, Oberender F, Leung AKC. How to manage acute respiratory distress syndrome. Drugs in Context 2021; 10: 2021-1-9. DOI: 10.7573/dic.2021-1-9

Contributions: KLH is the principal author. AKCL, KKYL and FO are coauthors who contributed and helped with the drafting of this manuscript. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: AKCL and KLH are associate editors of Drugs in Context and Guest Editors of the present series and confirm that they have no other conflicts of interest. This manuscript was sent out for independent peer review by the Managing Editor. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2021/04/dic.2021-1-9-COI.pdf

Acknowledgements: None.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2021 Hon KL, Leung KKY, Oberender F, Leung AKC. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified later. No commercial use without permission.

Correct attribution: Copyright © 2021 Hon KL, Leung KKY, Oberender F, Leung AKC. https://doi.org/10.7573/dic.2021-1-9. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/paediatrics:-how-to-manage-acute-respiratory-distress-syndrome

Correspondence: Kam Lun Hon, Department of Paediatrics and Adolescent Medicine, The Hong Kong Children’s Hospital, Hong Kong. Email: ehon@hotmail.com

Provenance: Invited; externally peer reviewed.

Submitted: 29 January 2020; Accepted: 17 March 2021; Publication date: 1 June 2021.

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