Pulmonary Specific Treatment of PARDS
The pathophysiologic and clinical features have triggered many investigators to study numerous pharmacological approaches to ARDS in critically ill adults [127]. Few of these approaches have been explored in critically ill children. As a consequence, much of the routine treatment for PARDS is based on data from adults or paediatric anecdotal experiences (Table 19.4). Despite this lack of scientific
Table 19.4 Summary of studies reporting on the use of pulmonary specific ancillary treatment in paediatric acute respiratory distress syndrome (PARDS)
|
Reference |
Number of patients Disease |
Intervention |
Findings and conclusions |
|
Exogenous surfactant |
|||
|
Willson et al. [22] |
N = 42 Acute hypoxaemic respiratory failure (OI >7) |
Calf surfactant vs air placebo |
Improved oxygenation, decreased ventilation time and shorter PICU stays |
|
Willson et al. [24] |
N = 153 Acute lung injury (OI > 7) |
Calf surfactant vs air placebo |
Improved oxygenation and decreased mortality. No difference in ventilator-free days (primary study outcome) |
|
Willson et al. [25] |
N = 109 Direct lung injury only |
Pneumosurf vs air placebo |
No effect on oxygenation or mortality |
|
Thomas et al. [26] |
N = 165 Acute hypoxaemic respiratory failure |
Lucinactant (synthetic surfactant) vs air placebo |
Improved oxygenation, but no effect on mortality, length of ventilation or length of stay |
|
Nitric oxide |
|||
|
Day et al. [33] |
N = 22 Acute bilateral lung disease |
10 ppm iNO vs control |
Improved OI and PVRI, but not mortality |
|
Dobyns et al. [34] |
N = 108 AHRF |
10 ppm iNO vs control |
Improved OI and PVRI, but not mortality |
|
Ibrahim et al. [35] |
N = 32 ARDS |
5 ppm iNO ± prone positioning vs control |
Improved OI, but not mortality |
|
Prone positioning |
|||
|
Curley et al. [73] |
N = 102 Acute lung injury (PaO2/FiO2 ratio < 300 mmHg) |
Prone positioning for 20 hours vs standard therapy |
Improved oxygenation, no effect on ventilator-free days or mortality |
evidence, many pulmonary-specific therapies including inhaled nitric oxide (iNO), surfactant or steroids are used in daily practice [124, 125].
