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Crit Care Med. 2009 Aug;37(8):2448-54. doi: 10.1097/CCM.0b013e3181aee5dd.

Management of acute lung injury and acute respiratory distress syndrome in children.

Author information

1
Division of Critical Care Medicine, Department of Anesthesia, Perioperative and Pain Medicine, Children's Hospital, Boston, MA, USA. Adrienne.Randolph@childrens.harvard.edu

Abstract

BACKGROUND:

Acute lung injury (ALI) and its more severe form, acute respiratory distress syndrome (ARDS), are devastating disorders of overwhelming pulmonary inflammation and hypoxemia, resulting in high morbidity and mortality.

AIM:

To provide the clinician with a summary of the literature on the epidemiology, diagnosis, and an evidence-base for management of ALI/ARDS in children.

DATA SELECTION:

PubMed search for clinical trials, selected literature review of other relevant studies on epidemiology and diagnosis. DATA SYNTHESIS AND RECOMMENDATIONS: Lower mortality combined with a relatively lower frequency of ALI/ARDS in children makes performance of clinical trials challenging. Based on expert opinion, the following are recommended: 1) avoid tidal volumes > or =10 mL/kg body weight; 2) keep plateau pressure < or =30 cm H2O, arterial pH at 7.30 to 7.45, and Pao2 60 to 80 torr (8 to 10.7 kPa) (Spo2 > or =90%); 3) provide sedation, analgesia, and stress ulcer prophylaxis; and 4) use a 10 g/dL hemoglobin threshold for packed red blood cell transfusion in unstable patients (shock or profound hypoxia). Evidence supports dropping the hemoglobin transfusion threshold to 7 g/dL once profound hypoxia and shock have resolved. Promising therapies for pediatric ALI/ARDS based on pediatric studies include endotracheal surfactant, high-frequency oscillatory ventilation, noninvasive ventilation, and use of extracorporeal membrane oxygenation as a rescue therapy. Promising therapies based on adult trials include use of corticosteroids for lung inflammation and fibrosis, use of 4 to 6 mL/kg tidal volumes and restrictive fluid management. Prone positioning, bronchodilators, inhaled nitric oxide, tight glucose control, and high-flow nasal cannula (HFNC) oxygen are therapies that require further study before they can be recommended for children with ALI/ARDS.

PMID:
19531940
DOI:
10.1097/CCM.0b013e3181aee5dd
[Indexed for MEDLINE]

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