LITERATURE REVIEW
Anesthesiology and Critical Care Medicine
doi: 10.25005/2074-0581-2024-26-2-272-283
PEDIATRIC ACUTE RESPIRATORY DISTRESS SYNDROME: PRACTICAL ASPECTS OF INTENSIVE THERAPY

YU.V. BYKOV1,2, A. N. OBEDIN1,3, V.V. FISHER1,4, E.V. VOLKOV1,5

1Department of Anesthesiology and Resuscitation with a Course of Additional Professorial Education, Stavropol State Medical University, Stavropol, Russian Federation
2Children's City Clinical Hospital named after G.K. Filippsky, Stavropol, Russian Federation
3Stavropol Regional Clinical Perinatal Center No. 1, Stavropol, Russian Federation
4Shpakovskaya District Hospital, Mikhaylovsk, Russian Federation
5City Clinical Hospital of Emergency Medical Care, Stavropol, Russian Federation

A literature review on the intensive care of pediatric acute respiratory distress syndrome (pARDS) was conducted. Information was collected by searching in ScienceDirect, PubMed, and eLibrary databases. Keywords such as "acute respiratory syndrome," "children," "intensive care," and "mechanical ventilation" were used as search terms. The review included full-text publication with statistical data analysis. Publications on the treatment of ARDS in adult patients were excluded. There are currently no proven pharmacological treatments for pARDS, and there is a lack of randomized clinical trials. Treatment mainly involves respiratory support, infusion therapy, sedation, administration of glucocorticoids (GCs), and enteral nutrition. If necessary, non-invasive ventilation with positive end-expiratory pressure is performed as the initial respiratory support method. If it is ineffective and accompanied by evidence of  increasing respiratory failure, tracheal intubation and artificial ventilation are utilized. No substantial evidence supports the use of GCs for this condition. Despite the high prevalence and mortality rates of pARDS, there is still a need to optimize intensive care algorithms and the quality of care for this condition based on more extensive randomized clinical trials.

Keywords: Children, acute respiratory distress syndrome, intensive care, mechanical ventilation, glucocorticosteroids.

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References
  1. Orloff KE, Turner DA, Rehder KJ. The current state of pediatric acute respiratory distress syndrome. Pediatr Allergy Immunol Pulmonol. 2019;32(2):35-44. https://doi.org/10.1089/ped.2019.0999
  2. Hough RF. Recent advances in pediatric acute respiratory distress syndrome (PARDS). Current Pediatrics Reports. 2017;5:228-36. https://doi.org/10.1007/ s40124-017-0146-3
  3. Schouten LR, Veltkamp F, Bos AP, van Woensel JB, Neto AS, Schultz MJ, et al. Incidence and mortality of acute respiratory distress syndrome in children: A systematic review and meta-analysis. Crit Care Med. 2016;44:819-29. https:// doi.org/10.1097/CCM.0000000000001388
  4. Matthay MA, Zemans RL, Zimmerman GA, Arabi YM, Beitler JR, Mercat A, et al. Acute respiratory distress syndrome. Nat Rev Dis Primers. 2019;5(1):18. https://doi.org/10.1038/s41572-019-0069-0
  5. Al-Sofyani KA. Corticosteroids treatment for pediatric acute respiratory syndrome: A critical review. Saudi Med J. 2023;44(5):440-9. https://doi. org/10.15537/smj.2023.44.5.20220672
  6. Wong JJ, Jit M, Sultana R, Mok YH, Yeo JH, Koh JW, et al. Mortality in pediatric acute respiratory distress syndrome: A systematic review and meta-analysis. J Intensive Care Med. 2019;34:563-71. https://doi.org/10.1177/0885066617705109
  7. Valentine SL, Bembea MM, Muszynski JA, Cholette JM, Doctor A, Spinella PC, et al. Consensus recommendations for RBC transfusion practice in critically ill children from the pediatric critical care transfusion and anemia expertise initiative. Pediatr Crit Care Med. 2018;19:884-98. https://doi.org/10.1097/ PCC.0000000000001613
  8. Allareddy V, Cheifetz IM. Clinical trials and future directions in pediatric acute respiratory distress syndrome. Ann Transl Med. 2019;7(19):514. https://doi. org/10.21037/atm.2019.09.14
  9. Schneider N, Johnson M. Management of paediatric acute respiratory distress syndrome. BJA Educ. 2022;22(9):364-70. https://doi.org/10.1016/j. bjae.2022.04.004
  10. Beltramo F, Khemani RG. Definition and global epidemiology of pediatric acute respiratory distress syndrome. Ann Transl Med. 2019;7(19):502. https://doi. org/10.21037/atm.2019.09.31
  11. Hon KL, Leung KKY, Oberender F, Leung AK. Paediatrics: How to manage acute respiratory distress syndrome. Drugs Context. 2021:10:2021-1-9. https://doi. org/10.7573/dic.2021-1-9
  12. Park J, Lee YJ, Lee J, Park SS, Cho YJ, Lee SM, et al. Histopathologic heterogeneity of acute respiratory distress syndrome revealed by surgical lung biopsy and its clinical implications. Korean J Intern Med. 2018;33(3):532-40. https://doi. org/10.3904/kjim.2016.346
  13. Snisar V.I. Ostryy respiratornyy distress-sindrom u detey. Chto novogo? [Acute respiratory distress syndrome in children. What's new?]. Meditsina neotlozhnykh sostoyaniy. 2017;5:9-14. https://doi.org/10.22141/2224- 0586.5.84.2017.109354
  14. Aleksandrovich YuS, Pshenisnov KV. Ostryy respiratornyy distress-sindrom v pediatricheskoy praktike [Acute respiratory distress syndrome in pediatric practice]. Vestnik intensivnoy terapii. 2014;3:23-9.
  15. Matthay MA, Thompson BT, Ware LB. The Berlin definition of acute respiratory distress syndrome: Should patients receiving high-flow nasal oxygen be included? Lancet Respir Med. 2021;9(8):933-6. https://doi.org/10.1016/S2213- 2600(21)00105-3
  16. Abusuev AA, Bulach TP. Ostryy respiratornyy distress-sindrom u detey: diagnostika i strategiya intensivnoy terapii [Acute respiratory distress syndrome in children: diagnosis and strategy of intensive care]. Vestnik Dagestanskoy gosudarstvennoy meditsinskoy akademii. 2018;3:59-65.
  17. Alshehri SS, Minhaji BI, Pasha MR, Fouda D, Joseph J, Ahmed N, et al. Characteristics and outcomes of children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted to a Quaternary Hospital: A single-center experience. Cureus. 2024;16(1):e52532. https://doi.org/10.7759/ cureus.52532
  18. Marroquín-Yáñez ML, Medeiros M, Chávez-López A, Carrillo-López HA, Soto-Bautista NP, Jarillo-Quijada AE, et al. Clinical characteristics of pediatric patients with acute respiratory distress syndrome due to COVID-19. Bol Med Hosp Infant Mex. 2022;79(3):170-9. https://doi.org/10.24875/BMHIM.21000163
  19. Monteverde-Fernández N, Cristiani F, McArthur J, González-Dambrauskas S. Steroids in pediatric acute respiratory distress syndrome. Ann Transl Med. 2019;7(19):508. https://doi.org/10.21037/atm.2019.07.77
  20. Tamburro RF, Kneyber MC; Pediatric Acute Lung Injury Consensus Conference Group. 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. https://doi. org/10.1097/PCC.0000000000000434
  21. Valentine SL, Kudchadkar SR, Ward S, Morrow BW, Nadkarni VM, Curley MA, et al. Nonpulmonary treatments for pediatric acute respiratory distress syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2023;24(12 Suppl 2):S45-S60. https://doi.org/10.1097/ PCC.0000000000003158
  22. Grotberg JC, Reynolds D, Kraft BD. Management of severe acute respiratory distress syndrome: A primer. Crit Care. 2023;27(1):289. https://doi.org/10.1186/ s13054-023-04572-w
  23. Essouri S, Carroll C. Noninvasive support and ventilation for pediatric acute respiratory distress syndrome. Pediatr Crit Care Med. 2015;16:S102-110. https:// doi.org/10.1097/PCC.0000000000000437
  24. Jouvet P, Thomas NJ, Willson DF. Pediatric acute respiratory distress syndrome: Consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16:428-39. https://doi.org/10.1097/ PCC.0000000000000350
  25. Battaglini D, Fazzini B, Silva PL, Cruz FF, Ball L, Robba C, et al. Challenges in ARDS definition, management, and identification of effective personalized therapies. J Clin Med. 2023;12(4):1381. https://doi.org/10.3390/jcm12041381
  26. Fujishima S. Guideline-based management of acute respiratory failure and acute respiratory distress syndrome. J Intensive Care. 2023;11(1):10. https:// doi.org/10.1186/s40560-023-00658-3
  27. Al-Ayed T, Alsarhi IB, Alturki A, Aljofan F, Alofisan F, Al Abdulsalam M, et al. The outcome of high-frequency oscillatory ventilation in pediatric patients with acute respiratory distress syndrome in an intensive care unit. Ann Saudi Med. 2023;43(5):283-90. https://doi.org/:10.5144/0256-4947.2023.283
  28. El-Nawawy A, Moustafa A, Heshmat H, Abouahmed A. High frequency oscillatory ventilation versus conventional mechanical ventilation in pediatric acute respiratory distress syndrome: A randomized controlled study. Turk J Pediatr. 2017;59:130-43. https://doi.org/10.24953/turkjped.2017.02.004
  29. Bateman ST, Borasino S, Asaro LA, Cheifetz IM, Diane S, Wypij D, et al. Early high-frequency oscillatory ventilation in pediatric acute respiratory failure: A propensity score analysis. Am J Respir Crit Care Med. 2016;193:495-503. https://doi.org/10.1164/rccm.201507-1381OC
  30. Oh TK, Song IA. Trend of extracorporeal membrane oxygenation support in patients with acute respiratory distress syndrome in South Korea. Sci Rep. 2022;12:5225. https://doi.org/10.1038/s41598-022-09230-9
  31. Combes A, Hajage D, Capellier G, Demoule A, Lavoué S, Guervilly C, et al. EOLIA Trial Group, REVA, and ECMON et Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378:1965-75. https://doi.org/10.1056/NEJMoa1800385
  32. Ryan L, Hurley T, Branagan A, Molloy E. Heliox for prevention of morbidity and mortality in ventilated newborn infants. Cochrane Database Syst Rev. 2023;2023(10):CD015049. https://doi.org/10.1002/14651858.CD015049
  33. Caudron M, Holt T, Cuvelier DE, Dmytrowich J, Hansen G. Pulmonary thromboses in pediatric acute respiratory distress syndrome. Respir Care. 2019;64(2):209-16. https://doi.org/10.4187/respcare.06106
  34. Lupton-Smith A, Argent A, Rimensberger P, Frerichs I, Morrow B. Prone positioning improves ventilation homogeneity in children with acute respiratory distress syndrome. Pediatr Crit Care Med. 2017;18:e229-34. https://doi. org/10.1097/PCC.0000000000001145
  35. Hoshino T, Yoshida T. Future directions of lung‐protective ventilation strategies in acute respiratory distress syndrome. Acute Med Surg. 2024;11(1):e918. https://doi.org/10.1002/ams2.918
  36. Leroue MK, Maddux AB, Mourani PM. Prone positioning in children with respiratory failure due to COVID-19. Curr Opin Pediatr. 2021;33(3):319-24. https:// doi.org/10.1097/MOP.0000000000001009
  37. Zinter MS, Spicer AC, Liu KD, Orwoll BE, Alkhouli MF, Brakeman PR, et al. Positive cumulative fluid balance is associated with mortality in pediatric acute respiratory distress syndrome in the setting of acute kidney injury. Pediatr Crit Care Med. 2019;20:323-31. https://doi.org/10.1097/PCC.0000000000001845
  38. Hartmann SM, Hough CL. Argument against the routine use of steroids for pediatric acute respiratory distress syndrome. Front Pediatr. 2016;4:79. https:// doi.org/10.3389/fped.2016.00079
  39. Cheifetz IM. Pediatric ARDS. Respir Care. 2017;62:718-31. https://doi. org/10.4187/respcare.05591
  40. Drago BB, Kimura D, Rovnaghi CR, Schwingshack A, Rayburn M, Meduri GU, et al. Double-blind, placebo-controlled pilot randomized trial of methylprednisolone infusion in pediatric acute respiratory distress syndrome. Pediatr Crit Care Med. 2015;16:e74–81. https://doi.org/10.1097/PCC.0000000000000349
  41. Yehya N, Servaes S, Thomas NJ, Nadkarni VM, Srinivasan V. Corticosteroid exposure in pediatric acute respiratory distress syndrome. Intensive Care Med. 2015;41:1658-66. https://doi.org/10.1007/s00134-015-3953-4
  42. Vet NJ, Kleiber N, Ista E, deHoog M, deWildt SN. Sedation in critically ill children with respiratory failure. Front Pediatr. 2016;4:89. https://doi.org/10.3389/ fped.2016.0008
  43. Curley MAQ, Wypij D, Watson RS, Grant MJ, Asaro LA, Cheifetz IM, et al. Protocolized sedation vs usual care in pediatric patients mechanically ventilated for acute respiratory failure: A randomized clinical trial. JAMA. 2015;313:379-89. https://doi.org/10.1001/jama.2014.18399
  44. Camprubí-Rimblas M, Tantinyà N, Bringué J, Guillamat-Prats R, Artigas A. Anticoagulant therapy in acute respiratory distress syndrome. Ann Transl Med. 2018;6(2):36. https://doi.org/10.21037/atm.2018.01.08
  45. Wong JJ, Han WM, Sultana R, Loh TF, Lee JH. Nutrition delivery affects outcomes in pediatric acute respiratory distress syndrome. J Parenter Enter Nutr. 2017;41:1007-13. https://doi.org/10.1177/ 0148607116637937
  46. Iyer R, Bansa lA. What do we know about optimal nutritional strategies in children with pediatric acute respiratory distress syndrome? Ann Transl Med. 2019;7:510. https://doi.org/10.21037/atm.2019.08.25

Authors' information:

Bykov Yuriy Vitalievich,
Candidate of Medical Sciences, Associate Professor of the Department of Anesthesiology and Intensive Care with a Course of Additional Professorial Education, Stavropol State Medical University; Anesthesiologist-Reanimatologist, Children's City Hospital named after G.K. Filippsky
ORCID ID: 0000-0003-4705-3823
E-mail: yubykov@gmail.com

Obedin Aleksandr Nikolaevich,
Doctor of Medical Sciences, Head of the of Department of Anesthesiology and Intensive Care with a Course of Additional Professorial Education, Stavropol State Medical University; Deputy Chief Physician for Pediatric Care, Stavropol Regional Clinical Perinatal Center No. 1
ORCID ID: 0000-0002-9990-7272
Е-mail: volander@mail.ru

Fischer Vasiliy Vladimirovich,
Candidate of Medical Sciences, Associate Professor of the Department of Anesthesiology and Intensive Care with a Course of Additional Professorial Education, Stavropol State Medical University; Deputy Chief Medical Officer, Shpakovskaya District Hospital
ORCID ID: 0000-0002-9841-6930
Е-mail: vvfisher26@gmail.com

Volkov Evgeniy Vladimirovich,
Candidate of Medical Sciences, Associate Professor of the Department of Anesthesiology and Intensive Care with a Course of Additional Professorial Education, Stavropol State Medical University; Head of the Department of Anesthesiology and Intensive Care No. 1, Stavropol Regional Clinical Hospital
ORCID ID: 0000-0002-9841-6930
Е-mail: volkov26@mail.ru

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The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Bykov Yuriy Vitalievich
Candidate of Medical Sciences, Associate Professor of the Department of Anesthesiology and Intensive Care with a Course of Additional Professorial Education, Stavropol State Medical University; Anesthesiologist-Reanimatologist, Children's City Hospital named after G.K. Filippsky

355031, Russian Federation, Stavropol, Mira str., 310

Теl.: +7 (962) 4430492

E-mail: yubykov@gmail.com

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