Paediatrics: how to manage acute respiratory distress syndrome

Kam Lun Hon, Karen Ka Yan Leung, Felix Oberender, Alexander KC Leung

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.

Article Details

Article Type

Review

DOI

10.7573/dic.2021-1-9

Categories

Publication Dates

Accepted: ; Published: .

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

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