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Management of oxygenation in pediatric acute hypoxemic respiratory failure
1Division of Pediatric Critical Care Medicine, MassGeneral Hospital for Children, Boston, Massachusetts 02114, USA.
Insights
Managing acute hypoxemic respiratory failure in children requires careful oxygenation strategies. This review guides pediatric pulmonologists on lung-protective ventilation and other methods to improve outcomes for acute respiratory distress syndrome (ARDS).
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Respiratory Physiology
Background:
- Acute Respiratory Distress Syndrome (ARDS) prognosis has improved since 1967.
- Acute hypoxemic respiratory failure is a key feature of acute lung injury and ARDS.
- Effective oxygenation management is critical for pediatric patients with ARDS.
Purpose of the Study:
- To review current strategies for managing oxygenation in pediatric acute hypoxemic respiratory failure.
- To provide guidance for pediatric pulmonologists treating children with ARDS.
- To discuss the impact of various lung-protective strategies on clinical outcomes.
Main Methods:
- Review of state-of-the-art oxygenation management strategies.
- Discussion of lung-protective ventilation, including low tidal volume and plateau pressure.
- Exploration of other potential strategies like PEEP, I:E ratios, recruitment maneuvers, and prone positioning.
Main Results:
- Lung-protective ventilation (low tidal volume, limited plateau pressure) improves outcomes.
- Other strategies (PEEP, I:E ratios, recruitment, prone positioning) may impact outcomes but need further study.
- Optimizing oxygenation is essential for managing pediatric ARDS.
Conclusions:
- Pediatric pulmonologists face complex oxygenation management choices for ARDS.
- Evidence-based strategies, particularly lung-protective ventilation, are crucial.
- Further research is needed for several adjunctive therapies in pediatric ARDS management.
Abstract:
The prognosis for patients with acute respiratory distress syndrome (ARDS) in adults and children has improved since its formal acceptance as a clinical entity in 1967. Because acute hypoxemic respiratory failure is the hallmark of acute lung injury and ARDS, the management of oxygenation is crucial. Physicians managing pediatric patients with acute lung injury or ARDS are faced with a complex array of options influencing oxygenation. Certain treatment strategies can influence clinical outcomes, such as a lung-protective ventilation strategy that specifies a low tidal volume (6 mL/kg) and a plateau pressure limit (30 cm H(2)O) (Acute Respiratory Distress Network, N Engl J Med 2000;342:1301-1308). Other lung-protective strategies such as different levels of positive end-expiratory pressure, altered inspiratory:expiratory ratios, recruitment maneuvers, prone positioning, and extraneous gases or drugs may impact clinical outcomes but require further clinical study. This paper reviews state-of-the-art strategies on the management of oxygenation in acute hypoxemic respiratory failure and attempts to guide pediatric pulmonologists in managing children with respiratory failure.