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)


Number of patients



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


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].

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