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Published on: April 7, 2021
Nonpulmonary Treatments for Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung
Stacey L Valentine1, Sapna R Kudchadkar2, Shan Ward3
1Department of Pediatrics, Division of Pediatric Critical Care, University of Massachusetts Children´s Medical Center, Worcester, MA.
Insights
This review updates nonpulmonary treatments for pediatric acute respiratory distress syndrome (PARDS). It provides clinical recommendations and good practice statements to optimize care and guide future research in PARDS management.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Pulmonology
Background:
- Pediatric Acute Respiratory Distress Syndrome (PARDS) requires comprehensive management strategies.
- Nonpulmonary adjunctive therapies play a crucial role in optimizing outcomes for children with PARDS.
- The Second Pediatric Acute Lung Injury Consensus Conference aimed to update the evidence base for these treatments.
Approach:
- Systematic literature review across major medical databases (MEDLINE, Embase, CINAHL).
- Inclusion of studies focusing on nonpulmonary therapies for PARDS or hypoxic respiratory failure.
- Application of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework for evidence synthesis.
Key Points:
- Five clinical practice recommendations were developed for neuromuscular blockade, nutrition, fluid management, and transfusion.
- Thirteen good practice statements address sedation, delirium, sleep, and rehabilitation in PARDS.
- Three research statements highlight areas for future investigation in nonpulmonary PARDS therapies.
Conclusions:
- The generated recommendations and statements aim to standardize and improve care for pediatric patients with PARDS.
- This evidence-based guidance addresses critical nonpulmonary aspects of PARDS management.
- Identifying research gaps will drive advancements in treating pediatric respiratory failure.
Objectives:
To provide an updated review of the literature on nonpulmonary treatments for pediatric acute respiratory distress syndrome (PARDS) from the Second Pediatric Acute Lung Injury Consensus Conference.
Data Sources:
MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost).
Study Selection:
Searches were limited to children with PARDS or hypoxic respiratory failure focused on nonpulmonary adjunctive therapies (sedation, delirium management, neuromuscular blockade, nutrition, fluid management, transfusion, sleep management, and rehabilitation).
Data Extraction:
Title/abstract review, full-text review, and data extraction using a standardized data collection form.
Data Synthesis:
The Grading of Recommendations Assessment, Development, and Evaluation approach was used to identify and summarize evidence and develop recommendations. Twenty-five studies were identified for full-text extraction. Five clinical practice recommendations were generated, related to neuromuscular blockade, nutrition, fluid management, and transfusion. Thirteen good practice statements were generated on the use of sedation, iatrogenic withdrawal syndrome, delirium, sleep management, rehabilitation, and additional information on neuromuscular blockade and nutrition. Three research statements were generated to promote further investigation in nonpulmonary therapies for PARDS.
Conclusions:
These recommendations and statements about nonpulmonary treatments in PARDS are intended to promote optimization and consistency of care for patients with PARDS and identify areas of uncertainty requiring further investigation.
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