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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
Advances in Management of Respiratory Failure in Children
Divakar Jose1, Narayanan Parameswaran2
1Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Insights
New respiratory support strategies, including non-invasive ventilation and advanced invasive methods, aim to improve care for sick children. Clinicians must judiciously select and manage these techniques to minimize lung injury and optimize outcomes.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Mechanical ventilation
Background:
- Effective respiratory support is crucial for treating critically ill children.
- Recent advancements focus on both non-invasive and invasive ventilation strategies.
- Optimizing patient outcomes requires careful selection and management of ventilatory support.
Purpose of the Study:
- To review recent advances in pediatric respiratory support.
- To highlight innovations in non-invasive and invasive ventilation.
- To discuss strategies for minimizing lung injury and improving patient comfort.
Main Methods:
- Review of current literature on respiratory support modalities.
- Discussion of novel non-invasive techniques like Heated humidified high-flow nasal cannula (HHHFNC).
- Exploration of advancements in invasive ventilation, including automation and monitoring (e.g., mechanical power, transpulmonary pressure, thoracic impedance tomography).
Main Results:
- Newer non-invasive modalities aim to reduce the need for invasive ventilation.
- Improvements in invasive ventilation focus on automation, patient comfort, and lung injury reduction.
- Monitoring techniques are evolving to better assess and prevent lung injury.
Conclusions:
- Judicious use of diverse ventilatory options, considering individual patient needs, is paramount.
- Pharmacological treatments for pediatric Acute Respiratory Distress Syndrome (ARDS) have shown limited success.
- Future directions include exploring pulmonary local drug and gene therapy via liquid ventilation.
Abstract:
Providing the right respiratory support is an essential skill, vital for anyone treating sick children. Recent advances in respiratory support include developments in both non-invasive and invasive ventilatory strategies. In non-invasive ventilation, newer modalities are being developed, in an attempt to decrease the need for invasive ventilation. This include newer techniques like Heated humidified high-flow nasal cannula (HHHFNC) and improvements in existing modes. The success of Continuous positive airway pressure (CPAP) and other non-invasive modes depend to a large extent on choosing and maintaining a suitable interface. When it comes to invasive ventilation, recent advances are focussing on increasing automation, improving patient comfort and minimising lung injury. Concepts like mechanical power are attempts at understanding the mechanisms of unintended injuries resulting from respiratory support and newer monitoring methods like transpulmonary pressure, thoracic impedance tomography are attempts at measuring potential markers of lung injury. Using the vast arrays of available ventilatory options judiciously, considering their advantages and drawbacks in every individual case will be the prime responsibility of clinicians in the future. Simultaneously, efforts have been made to identify potential drugs that can favourably modify the pathophysiology of acute respiratory distress syndrome (ARDS). Unfortunately, though eagerly awaited, most pharmaceutical agents tried in pediatric ARDS have not shown definite benefit. Pulmonary local drug and gene therapy using liquid ventilation strategies may revolutionize our future understanding and management of lung diseases.
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