Related Experiment Video

Updated: Apr 16, 2026

Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
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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

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Positive end-expiratory pressure in pediatric acute respiratory distress syndrome: a narrative review

Lauren Allen1, Palen Mallory1, Alexandre T Rotta1

  • 1Duke University Medical Center, Durham, NC, USA.

Translational Pediatrics
|April 15, 2026
PubMed

Insights

Positive end-expiratory pressure (PEEP) is crucial for managing pediatric acute respiratory distress syndrome (PARDS). While the ARDSnet PEEP:FiO2 table offers guidance, more pediatric-specific research is needed for optimal PEEP titration strategies.

Area of Science:

  • Critical Care Medicine
  • Pediatric Pulmonology
  • Respiratory Physiology

Background:

  • Pediatric acute respiratory distress syndrome (PARDS) presents significant morbidity and mortality.
  • Positive end-expiratory pressure (PEEP) is vital for lung recruitment, oxygenation, and preventing ventilator-induced lung injury (VILI).
  • Current evidence guiding PEEP titration in pediatric patients is limited, necessitating a review of existing strategies.

Purpose of the Study:

  • To review the physiologic principles of PEEP in PARDS.
  • To summarize current evidence for PEEP management in children.
  • To discuss bedside strategies for PEEP titration in pediatric patients.

Main Methods:

  • A narrative review of English-language studies published from 1967 to 2025 was conducted.
  • PubMed was searched using terms related to PARDS, PEEP, mechanical ventilation, and monitoring techniques.
  • Reference lists of key publications and guidelines were also screened.

Main Results:

  • The ARDSnet low PEEP:FiO2 table is the most evidence-based and easily applicable strategy currently available.
  • Other methods like compliance-based maneuvers, stress index, pressure-volume curves, imaging, esophageal manometry, and electrical impedance tomography (EIT) lack robust pediatric outcome data.
  • Esophageal manometry and EIT show promise for PEEP titration but require further validation in pediatric populations.

Conclusions:

  • Maintaining PEEP at or above ARDSNet lower-table recommendations is supported, with careful monitoring of physiologic responses.
  • Adjunctive monitoring with esophageal manometry or EIT may aid in balancing lung recruitment and overdistension.
  • Pediatric-specific trials and standardized multicenter studies are essential to establish evidence-based PEEP strategies for PARDS.
Abstract

Keywords:
Pediatric acute respiratory distress syndrome (PARDS)electrical impedance tomography (EIT)esophageal manometrypositive end-expiratory pressure (PEEP)stress index

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