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Published on: September 24, 2020
Adjunctive treatments in pediatric acute respiratory distress syndrome
Yee Hui Mok1, Jan Hau Lee, Kyle J Rehder
1Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore.
Insights
This review examines non-ventilatory treatments for acute respiratory distress syndrome (ARDS) in children, finding limited evidence for adjunctive strategies like prone positioning and pulmonary vasodilators in pediatric ARDS management.
Area of Science:
- Pediatric Critical Care Medicine
- Pulmonology
- Neonatology
Background:
- Acute respiratory distress syndrome (ARDS) is a severe lung condition characterized by inflammation and hypoxemic respiratory failure.
- Despite improved management, pediatric ARDS still has a significant mortality rate of up to 35%.
- Invasive mechanical ventilation is standard, but evidence for non-ventilatory adjuncts in children is scarce.
Purpose of the Study:
- To review existing evidence on non-ventilatory adjunctive strategies for pediatric ARDS.
- To evaluate the efficacy and support for treatments beyond mechanical ventilation in infants and children.
Main Methods:
- Systematic review of current literature.
- Analysis of evidence for specific non-ventilatory adjuncts.
- Focus on pediatric ARDS populations.
Main Results:
- Limited high-quality evidence supports many non-ventilatory adjuncts in pediatric ARDS.
- Prone positioning, pulmonary vasodilators, beta-agonists, steroids, and surfactant efficacy require further investigation.
- Data gaps exist for optimal adjunctive therapy in pediatric populations.
Conclusions:
- Current evidence for non-ventilatory adjuncts in pediatric ARDS is insufficient.
- Further research is crucial to establish evidence-based guidelines for these treatments in children.
- Optimizing ARDS care in pediatric patients necessitates robust data on adjunctive therapies.
Abstract:
Acute respiratory distress syndrome (ARDS) is a devastating process that involves pulmonary inflammation, alveolar damage and hypoxemic respiratory failure. Although advances in management approaches over the past two decades have resulted in significantly improved outcomes, death from pediatric ARDS may still occur in up to 35% of patients. While invasive mechanical ventilation is an essential component of ARDS management, various adjuncts have been utilized as treatment for these patients. However, evidence-based data in infants and children in this area are lacking. In this article, the authors review the available evidence supporting (or not supporting) the use of non-ventilatory adjunctive strategies in the management of pediatric ARDS, including prone positioning, pulmonary vasodilators, β-agonists, steroids and surfactant.
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