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Review
. 2023 Feb 1;24(12 Suppl 2):S99-S111.
doi: 10.1097/PCC.0000000000003162. Epub 2023 Jan 20.

Pulmonary Specific Ancillary Treatment for Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

Courtney M Rowan  1 , Adrienne G Randolph  2   3 , Narayan Prabhu Iyer  4 , Steven Kwasi Korang  5   6 , Martin C J Kneyber  7   8 ; Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Collaborators, Affiliations
Review

Pulmonary Specific Ancillary Treatment for Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

Courtney M Rowan et al. Pediatr Crit Care Med. .

Abstract

Objectives: We conducted an updated review of the literature on pulmonary-specific ancillary therapies for pediatric acute respiratory distress syndrome (PARDS) to provide an update to the Pediatric Acute Lung Injury Consensus Conference recommendations and statements about clinical practice and research.

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

Study selection: Searches were limited to children, PARDS or hypoxic respiratory failure and overlap with pulmonary-specific ancillary therapies.

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-six studies were identified for full-text extraction. Four clinical recommendations were generated, related to use of inhaled nitric oxide, surfactant, prone positioning, and corticosteroids. Two good practice statements were generated on the use of routine endotracheal suctioning and installation of isotonic saline prior to endotracheal suctioning. Three research statements were generated related to: the use of open versus closed suctioning, specific methods of airway clearance, and various other ancillary therapies.

Conclusions: The evidence to support or refute any of the specific ancillary therapies in children with PARDS remains low. Further investigation, including a focus on specific subpopulations, is needed to better understand the role, if any, of these various ancillary therapies in PARDS.

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Conflict of interest statement

Dr. Rowan’s institution received funding from the National Heart, Lung, and Blood Institute (K23HL150244). Dr. Randolph’s institution received funding from the National Institute of Allergy and Infectious Diseases (NIAID); she received funding from Pediatric Critical Care Section Editor of UptoDate; and she received funding from the Centers for Disease Control and Prevention, National Institutes of Health (NIH) (NIAID AI154470). Dr. Kneyber received research funding from the NIH/National Institute of Child Health and Human Development (UG3 HL141736-01/U24 HL141723-01) and The Netherlands Organisation for Health Research and Development (848041002), Stichting Vrienden Beatrix Kinderziekenhuis, Fonds NutsOhra, University Medical Center Groningen, Free University Medical Center, and the Royal Academy of Dutch Sciences (TerMeulen stipend); his research program is technically supported by Vyaire, Applied Biosignals, and Timpl; he received honoraria from Vyaire; he serves as a consultant for Metran and served as a consultant for Vyaire; and he is also a co-principal investigator of the PRone and OScillation Pediatric Clinical Trial, investigating the impact of prone positioning and high-frequency oscillation in pediatric acute respiratory distress syndrome. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. Randolph AG: Management of acute lung injury and acute respiratory distress syndrome in children. Crit Care Med 2009; 37:2448–2454
    1. Guérin C, Reignier J, Richard JC, et al.; PROSEVA Study Group: Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013; 368:2159–2168
    1. Guerin C, Beuret P, Constantin JM, et al.; investigators of the APRONET Study Group, the REVA Network, the Réseau recherche de la Société Française d’Anesthésie-Réanimation (SFAR-recherche) and the ESICM Trials Group: A prospective international observational prevalence study on prone positioning of ARDS patients: The APRONET (ARDS Prone Position Network) study. Intensive Care Med 2018; 44:22–37
    1. Fernandez R, Trenchs X, Klamburg J, et al.: Prone positioning in acute respiratory distress syndrome: A multicenter randomized clinical trial. Intensive Care Med 2008; 34:1487–1491
    1. Taccone P, Pesenti A, Latini R, et al.; Prone-Supine II Study Group: Prone positioning in patients with moderate and severe acute respiratory distress syndrome: A randomized controlled trial. JAMA 2009; 302:1977–1984

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