Test Your Knowledge on Pediatric Acute Respiratory Distress Syndrome

Lung-Protective Ventilation and Non-Invasive Positive Pressure Ventilation in Pediatric Acute Respiratory Distress Syndrome (PARDS)

• Non-invasive positive pressure ventilation (NPPV) can be considered in children with mild PARDS, as it can improve airway opening, alveolar recruitment, and oxygenation.
• A randomized controlled trial with 50 patients showed that NPPV significantly lowered the frequency of endotracheal intubation in PARDS patients.
• However, NPPV is not recommended for patients with severe hypoxemia.
• Intubation and invasive ventilation is indicated when there are signs of increased respiratory effort, decreased PaO2/FiO2 ratio, or altered levels of consciousness.
• Lung-protective ventilation strategies aim to avoid volutrauma and minimize atelectrauma.
• Optimal tidal volume in PARDS patients remains controversial and is usually based on data extrapolated from adult patients.
• A higher tidal volume is associated with higher mortality and shorter ventilation-free days, while a lower tidal volume is associated with reduced mortality and an increase in ventilation-free days.
• A high maximum and median tidal volume is associated with lower mortality, but a 2014 meta-analysis showed no significant association between tidal volume and mortality.
• PALICC recommends patient-specific tidal volume based on lung compliance, with a physiological range of 5-8 mL/kg for good lung compliance and 3-6 mL/kg for poor lung compliance.
• Adequate PEEP is necessary to prevent atelectrauma in patients with PARDS, and moderately elevated levels of PEEP (10-15 cm H2O) are recommended for titration of oxygenation and hemodynamic response.
• A PEEP level greater than 15 cm H2O might be required for severe PARDS.
• Children managed with PEEP lower than recommended by the ARDSNet PEEP/FiO2 model had a higher mortality, according to a retrospective analysis of PARDS patients.