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Approaches in the management of acute respiratory failure in children

Margaret A Priestley1, Mark A Helfaer

  • 1Department of Anesthesiology and Critical Care Medicine, The University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, 19104, USA. Priestly@email.chop.edu

Current Opinion in Pediatrics
|May 29, 2004
PubMed

Insights

New strategies for pediatric acute respiratory distress syndrome (ARDS) focus on protective ventilation and adjunctive therapies to minimize lung injury and improve outcomes. Further clinical trials are needed to confirm efficacy.

Area of Science:

  • Pediatric critical care medicine
  • Respiratory physiology
  • Neonatology

Background:

  • Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are critical conditions in children, leading to substantial illness and death.
  • Current management of pediatric ARDS lacks definitive preventive strategies.

Purpose of the Study:

  • To review current strategies for minimizing ventilator-induced lung injury in pediatric ALI/ARDS.
  • To highlight novel adjunctive therapies for improving clinical outcomes in pediatric ARDS.

Main Methods:

  • Review of current literature on ventilatory strategies and adjunctive therapies for pediatric ALI/ARDS.
  • Analysis of evidence for protective ventilation modes, lung recruitment maneuvers, and pharmacological interventions.

Main Results:

  • Protective ventilation includes high-frequency oscillatory ventilation, airway pressure release ventilation, and partial liquid ventilation.
  • Lung-protective strategies such as recruitment maneuvers, prone positioning, and kinetic therapy enhance oxygenation.
  • Adjunctive therapies like inhaled nitric oxide, surfactant, specialized enteral formulas, and extracorporeal life support show potential but require further investigation.

Conclusions:

  • A combination of protective ventilation and adjunctive therapies is anticipated to optimize treatment and outcomes for pediatric ARDS.
  • Large, controlled clinical trials are essential to validate the effectiveness of these combined therapeutic approaches in pediatric populations.
Abstract

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