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Published on: August 30, 2019
Acute respiratory failure in children
1Department of Anesthesia/Critical Care, Children's Hospital, MICU, Boston, Massachusetts 02115, USA. bateman@a1.tch.harvard.edu
Insights
New strategies for pediatric acute respiratory failure focus on reducing lung injury and exploring immunomodulation. Promising therapies include early surfactant and enteral anti-inflammatory treatments, while inhaled nitric oxide shows limited benefit.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Immunomodulation therapies
Background:
- Acute respiratory failure in children presents significant challenges.
- Ventilator-induced lung injury (VILI) is a concern, observed in animal models and adults.
- Previous research explored various treatments, including mechanical ventilation strategies and immunomodulatory agents.
Purpose of the Study:
- To review recent advancements in treating pediatric acute respiratory failure.
- To evaluate novel therapeutic approaches aimed at reducing ventilator-induced lung injury and improving patient outcomes.
- To assess the efficacy of immunomodulatory therapies in pediatric respiratory failure.
Main Methods:
- Review of recent studies on pediatric acute respiratory failure treatments.
- Analysis of findings related to mechanical ventilation strategies (e.g., low tidal volume, high positive end-expiratory pressure).
- Evaluation of adjunctive therapies such as inhaled nitric oxide, intratracheal surfactant, enteral anti-inflammatory/antioxidant agents, and corticosteroids.
Main Results:
- Low tidal volume and high positive end-expiratory pressure strategies show survival benefits in adults.
- Inhaled nitric oxide provides transient oxygenation improvements but no proven outcome benefits.
- Early intratracheal surfactant may reduce mechanical ventilation duration; enteral anti-inflammatory/antioxidant therapies show promise in surrogate outcomes; corticosteroids may benefit late-stage lung injury.
Conclusions:
- Reducing ventilator-induced lung injury and exploring immunomodulation are key research areas.
- Early surfactant administration and enteral therapies hold promise for improving outcomes in pediatric respiratory failure.
- Further research is needed to confirm the efficacy of novel therapies, including corticosteroids, in pediatric populations.
Abstract:
Recent studies in the treatment of acute respiratory failure in children have been targeted at reducing ventilator-induced lung injury, providing treatment adjuncts to mechanical ventilation, and assessing innovative therapies directed at immunomodulation. Ventilator-associated lung injury has been demonstrated in animal models during the delivery of moderate-to-large tidal volumes and has also been described in adult populations. Subsequently, a significant survival benefit of a low tidal volume, high positive end expiratory pressure strategy on the ventilatory was found in adults. Investigation of the effects of inhaled nitric oxide in acute respiratory failure patients continues to show transient improvements in oxygenation, but no evidence of improved outcomes. The use of intratracheal surfactant within 24 hours of intubation in pediatric respiratory failure may be beneficial in reducing the days of mechanical ventilation. Neutrophil oxidative damage has been demonstrated, but therapies directed at decreasing neutrophil adherence have failed to demonstrate improvements. Enteral anti-inflammatory and antioxidant therapy may be promising, because these modalities have been shown to improve a number of surrogate outcomes in patients with respiratory failure. The use of corticosteroids in the late stages of lung injury has also recently been shown to have promise.
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