Abstract
Treatments for pediatric acute respiratory distress syndrome (PARDS) targeting the pulmonary system, other than mechanical ventilation, will be reviewed in this chapter. Many approaches have been used, but unfortunately, there is little medical evidence to guide clinicians in the appropriate use of them. The prone position, inhaled nitric oxide, and surfactant have been studied but have failed to consistently show improved outcomes in children with PARDS. Corticosteroids and the appropriate application of respiratory care, such as pulmonary hygiene, are less well studied. Clinicians are forced to apply limited pediatric research and studies on adult patients to guide the care of children with PARDS. Several therapies may be considered on a case-by-case basis after weighing potential benefits against the risks and costs of the therapy, but no ancillary pulmonary treatment would be considered standard of care in PARDS.
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Johnson NJ, Luks AM, Glenny RW. Gas exchange in the prone posture. Respir Care. 2017;62:1097–110.
Piehl MA, Brown RS. Use of extreme position changes in acute respiratory failure. Crit Care Med. 1976;4:13–4.
Curley MA, Thompson JE, Arnold JH. The effects of early and repeated prone positioning in pediatric patients with acute lung injury. Chest. 2000;118:156–63.
Kornecki A, Frndova H, Coates AL, et al. 4A randomized trial of prolonged prone positioning in children with acute respiratory failure. Chest. 2001;119:211–8.
Bruno F, Piva JP, Garcia PC, et al. Short-term effects of prone positioning on the oxygenation of pediatric patients submitted to mechanical ventilation. J Pediatr. 2001;77:361–8.
Casado-Flores J, Martinez de Azagra A, Ruiz-Lopez MJ, et al. Pediatric ARDS: effect of supine-prone postural changes on oxygenation. Intensive Care Med. 2002;28:1792–6.
Curley MA, Hibberd PL, Fineman LD, et al. Effect of prone positioning on clinical outcomes in children with acute lung injury: a randomized controlled trial. JAMA. 2005;294:229–37.
Fineman LD, LaBrecqu MA, Shih MC, et al. Prone positioning can be safely performed in critically ill infants and children. Pediatr Crit Care Med. 2006;7:413–22.
Sud S, Sud M, Friedrich JO, et al. Effect of prone positioning in patients with acute respiratory distress syndrome and high simplified acute physiology score II. Crit Care Med. 2008;36:2711–2.
Sud S, Friedrich JO, Taccone P, et al. Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: systematic review and meta-analysis. Intensive Care Med. 2010;36:585–99.
Guérin C, Reignier J, Ricjhard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368:2159–68.
Relvas MS, Silver PC, Sagy M. Prone positioning of pediatric patients with ARDS results in improvement in oxygenation if maintained > 12 h daily. Chest. 2003;124:269–74.
Sheridan RL, Zapol WM, Ritz RH, et al. Low-dose inhaled nitric oxide in acutely burned children with profound respiratory failure. Surgery. 1999;126:856–62.
Tang SF, Sherwood MC, Miller OI. Randomised trial of three doses of inhaled nitric oxide in acute respiratory distress syndrome. Arch Dis Child. 1998;79:415–8.
Day RW, Allen EM, Witte MK. A randomized, controlled study of the 1-hour and 24-hour effects of inhaled nitric oxide therapy in children with acute hypoxemic respiratory failure. Chest. 1997;112:1324–31.
Dobyns EL, Cornfield DN, Anas NG, et al. Multicenter randomized controlled trial of the effects of inhaled nitric oxide therapy on gas exchange in children with acute hypoxemic respiratory failure. J Pediatr. 1999;134:406–12.
Afshari A, Brok J, Møller AM, et al. Inhaled nitric oxide for acute respiratory distress syndrome and acute lung injury in adults and children: a systematic review with meta-analysis and trial sequential analysis. Anesth Analg. 2011;112:1411–21.
Macrae DJ, Field D, Mercier JC, et al. Inhaled nitric oxide therapy in neonates and children: reaching a European consensus. Intensive Care Med. 2004;30:372–80.
Tamburro RF, Kneyber MCJ. Pulmonary specific ancillary treatment for pediatric acute respiratory distress syndrome: proceedings from the pediatric acute lung injury consensus conference. Pediatr Crit Care Med. 2015;16:S61–72.
Thomas CA, Valentine K. Utility of routine methemoglobin laboratory assays in critically ill pediatric subjects receiving inhaled nitric oxide. J Crit Care. 2018;48:63–5.
Howard LS, Morrell NW. New therapeutic agents for pulmonary vascular disease. Paediatr Respir Rev. 2005;6:285–91.
Cornet AD, Hofstra JJ, Swart EL, et al. Sildenafil attenuates pulmonary arterial pressure but does not improve oxygenation during ARDS. Intensive Care Med. 2010;36:758–64.
Peter JV, John P, Graham PL, et al. Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS) in adults: meta-analysis. BMJ. 2008;336:1006–9.
Tang BM, Craig JC, Eslick GD, et al. Use of corticosteroids in acute lung injury and acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care Med. 2009;37:1594–603.
Tizon R, Frey N, Heitjan DF, et al. High-dose corticosteroids with or without etanercept for the treatment of idiopathic pneumonia syndrome after Allo-SCT. Bone Marrow Transplant. 2012;47:1332–7.
Yanik G, Grupp S, Pulsipher MA, et al. Competitive TNF inhibitor (ETANERCEPT) for the treatment of idiopathic pneumonia syndrome (IPS) following allogeneic stem cell transplantation (SCT). A joint pediatric blood and marrow transplant consortium (PBMTC) and children’s oncology group (COG) study. Biol Blood Marrow Transplant. 2013;19:S111–2.
Yanik G, Ho VT, Horowitz M, et al. Randomized, double blind, placebo-controlled trial of a TNF inhibitor (ETANERCEPT) for the treatment of idiopathic pneumonia syndrome (IPS) after allogeneic stem cell transplant (SCT). A blood and marrow transplant clinical trials network (BMT CTN) study. Biol Blood Marrow Transplant. 2013;19:S169.
Petty TL, Reiss OK, Paul GW, et al. Characteristics of pulmonary surfactant in adult respiratory distress syndrome associated with trauma and shock. Am Rev Respir Dis. 1977;115:531–6.
Hallman M, Spragg R, Harrell JH, et al. Evidence of lung surfactant abnormality in respiratory failure. Study of bronchoalveolar lavage phospholipids, surface activity, phospholipase activity, and plasma myoinositol. J Clin Invest. 1982;70:673–83.
Gregory TJ, Longmore WJ, Moxley MA, et al. Surfactant chemical composition and biophysical activity in acute respiratory distress syndrome. J Clin Invest. 1991;88:1976–81.
Willson DF, et al. Calf’s lung surfactant extract in acute hypoxemic respiratory failure in children. Crit Care Med. 1996;24(8):1316–22.
Luchetti M, Casiraghi G, Valsecchi R, et al. Porcine-derived surfactant treatment of severe bronchiolitis. Acta Anaesthesiol Scand. 1998;42:805–10.
Luchetti M, Ferrero F, Gallini C, et al. Multicenter, randomized, controlled study of porcine surfactant in severe respiratory syncytial virus-induced respiratory failure. Pediatr Crit Care Med. 2002;3:261–8.
Willson DF, Zaritsky A, Bauman LA, et al. Instillation of calf lung surfactant extract (calfactant) is beneficial in pediatric acute hypoxemic respiratory failure. Members of the Mid-Atlantic Pediatric Critical Care Network. Crit Care Med. 1999;27:188–95.
Möller JC, Schaible T, Roll C, et al. Surfactant ARDS study group. Treatment with bovine surfactant in severe acute respiratory distress syndrome in children: a randomized multicenter study. Intensive Care Med. 2003;29:437–46.
Willson DF, Thomas NJ, Markovitz BP, et al. Effect of exogenous surfactant (calfactant) in pediatric acute lung injury: a randomized controlled trial. JAMA. 2005;293:470–6.
Thomas NJ, Spear D, Wasserman E, et al. CALIPSO: a randomized controlled trial of calfactant for acute lung injury in pediatric stem cell and oncology patients. Biol Blood Marrow Transplant. 2018;24:2479–86.
Willson DF, Thomas NJ, Tamburro R, et al. Pediatric calfactant in acute respiratory distress syndrome trial. Pediatr Crit Care Med. 2013;14:657–65.
Choong K, Chatrkaw P, Frndova H, et al. Comparison of loss in lung volume with open versus in-line catheter endotracheal suctioning. Pediatr Crit Care Med. 2003;4:69–73.
Boothroyd AE, Murthy BV, Darbyshire A, et al. Endotracheal suctioning causes right upper lobe collapse in intubated children. Acta Paediatr. 1996;85:1422–5.
Ridling DA, Martin LD, Bratton SL. Endotracheal suctioning with or without instillation of isotonic sodium chloride solution in critically ill children. Am J Crit Care. 2003;12:212–9.
Shein SL, Gallagher JT, Deakins KM. Prophylactic use of nebulized hypertonic saline in mechanically ventilated children: a randomized blinded pilot study. Respir Care. 2016;61:586–92.
Singh B, Tiwari AK, Singh K, et al. β2 agonist for the treatment of acute lung injury: A systematic review and meta-analysis. Respir Care. 2014;59:288–96.
Abu-Hasan MN, Chesrown SE, Jantz MA. Successful use of bronchoscopic lung insufflation to treat left lung atelectasis. Pediatr Pulmonol. 2013;48:306–9.
Nakamura CT, Ripka JF, McVeigh K, et al. Bronchoscopic instillation of surfactant in acute respiratory distress syndrome. Pediatr Pulmonol. 2001;31:317–20.
Rafat N, Tönshoff B, Bierhaus A, Beck GC. Endothelial progenitor cells in regeneration after acute lung injury: do they play a role? Am J Respir Cell Mol Biol. 2013;48:399–405.
Lam CF, Liu YC, Hsu JK, et al. Autologous transplantation of endothelial progenitor cells attenuates acute lung injury in rabbits. Anesthesiology. 2008;108:392–401.
Mao M, Wang SN, Lv XJ, et al. Intravenous delivery of bone marrow-derived endothelial progenitor cells improves survival and attenuates lipopolysaccharide-induced lung injury in rats. Shock. 2010;34:196–204.
Zhu H, Xiong Y, Xia Y, et al. Therapeutic effects of human umbilical cord-derived mesenchymal stem cells in acute lung injury mice. Sci Rep. 2017;7:39889.
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Beardsley, A.L. (2020). Ancillary Pulmonary Treatments for Pediatric Acute Respiratory Distress Syndrome. In: Shein, S., Rotta, A. (eds) Pediatric Acute Respiratory Distress Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-030-21840-9_10
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DOI: https://doi.org/10.1007/978-3-030-21840-9_10
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