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Review
. 2023 Feb 1;24(12 Suppl 2):S45-S60.
doi: 10.1097/PCC.0000000000003158. Epub 2023 Jan 20.

Nonpulmonary Treatments for Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

Stacey L Valentine  1 , Sapna R Kudchadkar  2 , Shan Ward  3 , Brenda M Morrow  4 , Vinay M Nadkarni  5 , Martha A Q Curley  5 ; Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Collaborators, Affiliations
Review

Nonpulmonary Treatments for Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

Stacey L Valentine et al. Pediatr Crit Care Med. .

Abstract

Objectives: To provide an updated review of the literature on nonpulmonary treatments for pediatric acute respiratory distress syndrome (PARDS) from the Second Pediatric Acute Lung Injury Consensus Conference.

Data sources: MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost).

Study selection: Searches were limited to children with PARDS or hypoxic respiratory failure focused on nonpulmonary adjunctive therapies (sedation, delirium management, neuromuscular blockade, nutrition, fluid management, transfusion, sleep management, and rehabilitation).

Data extraction: Title/abstract review, full-text review, and data extraction using a standardized data collection form.

Data synthesis: The Grading of Recommendations Assessment, Development, and Evaluation approach was used to identify and summarize evidence and develop recommendations. Twenty-five studies were identified for full-text extraction. Five clinical practice recommendations were generated, related to neuromuscular blockade, nutrition, fluid management, and transfusion. Thirteen good practice statements were generated on the use of sedation, iatrogenic withdrawal syndrome, delirium, sleep management, rehabilitation, and additional information on neuromuscular blockade and nutrition. Three research statements were generated to promote further investigation in nonpulmonary therapies for PARDS.

Conclusions: These recommendations and statements about nonpulmonary treatments in PARDS are intended to promote optimization and consistency of care for patients with PARDS and identify areas of uncertainty requiring further investigation.

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Conflict of interest statement

Dr. Morrow’s institution received funding from the National Research Foundation of Southern Africa, EuroQual Group, and Society of Critical Care Medicine/Pediatric Critical Care Medicine; she received funding from the University of Cape Town. Dr. Nadkarni is an elected member of the Executive Committee (Council) of the Society of Critical care Medicine. The views presented are those of the author and do not represent the views of the SCCM organization. Dr. Curley’s institution received funding from the National Heart, Lung, and Blood Institute and the National Institute for Child Health and Human Development. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. Valentine SL, Nadkarni VM, Curley MA; Pediatric Acute Lung Injury Consensus Conference Group: Nonpulmonary treatments for pediatric acute respiratory distress syndrome: Proceedings from the pediatric acute lung injury consensus conference. Pediatr Crit Care Med 2015; 16(5 Suppl 1):S73–S85
    1. Iyer P, Khemani R, Emeriaud G, et al.: Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) for the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network: Methodology of the second pediatric acute lung injury consensus conference. Pediatr Crit Care Med 2023; 24(Suppl 1):S76–S86
    1. Smith HAB, Besunder JB, Betters KA, et al.: 2022 Society of Critical Care Medicine clinical practice guidelines on prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility. Pediatr Crit Care Med 2022; 23:e74–e110
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