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Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome (ARDS)
Published on: April 7, 2021
Acute respiratory distress syndrome
1Division of Pediatric Critical Care, University of Alabama, Birmingham, AL 35233, USA. pprabhakaran@peds.uab.edu
Indian Pediatrics
|November 5, 2010
Summary
Low tidal volume ventilation is the only proven strategy to improve outcomes in pediatric acute respiratory distress syndrome (ARDS). This approach helps minimize ventilator-induced lung injury and associated multi-organ failure in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- Acute respiratory distress syndrome (ARDS) is a frequent and severe condition in pediatric intensive care units.
- ARDS presents heterogeneity in causes and significant mortality risk.
- Numerous supportive therapies are available for managing pediatric ARDS.
Purpose of the Study:
- To review current evidence on supportive therapies for pediatric acute respiratory distress syndrome (ARDS).
- To identify strategies that improve outcomes in children with ARDS.
- To evaluate the efficacy of various interventions based on recent pediatric randomized controlled trials.
Main Methods:
- Literature search conducted on PubMed using keywords 'ARDS' and related terms.
- Inclusion of pediatric randomized controlled trials published within the last 10 years.
- Emphasis on pediatric literature, supplemented by key adult studies; evidence levels I and II prioritized.
Main Results:
- Low tidal volume ventilation (≤ 6 mL/kg predicted body weight) is the sole strategy consistently improving ARDS outcomes.
- Judicious use of positive end-expiratory pressure is recommended for lung recruitment.
- Insufficient evidence exists for routine use of high-frequency ventilation, prone positioning, or inhaled nitric oxide.
- Calfactant therapy shows promise for direct lung injury ARDS; routine corticosteroids are not supported.
Conclusions:
- Low tidal volume ventilation is crucial for improving outcomes and minimizing lung injury in pediatric ARDS.
- Careful application of positive end-expiratory pressure is essential.
- Further research is needed to establish the role of emerging therapies like calfactant.
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