Nonpulmonary Treatments for Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference.

Objectives: To provide an updated review of the literature on nonpulmonary treatments for pediatric acute respiratory distress syndrome (PARDS) from the Second Pediatric Acute Lung Injury Consensus Conference.
Data Sources: MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost).
Study Selection: Searches were limited to children with PARDS or hypoxic respiratory failure focused on nonpulmonary adjunctive therapies (sedation, delirium management, neuromuscular blockade, nutrition, fluid management, transfusion, sleep management, and rehabilitation).
Data Extraction: Title/abstract review, full-text review, and data extraction using a standardized data collection form.
Data Synthesis: The Grading of Recommendations Assessment, Development, and Evaluation approach was used to identify and summarize evidence and develop recommendations. Twenty-five studies were identified for full-text extraction. Five clinical practice recommendations were generated, related to neuromuscular blockade, nutrition, fluid management, and transfusion. Thirteen good practice statements were generated on the use of sedation, iatrogenic withdrawal syndrome, delirium, sleep management, rehabilitation, and additional information on neuromuscular blockade and nutrition. Three research statements were generated to promote further investigation in nonpulmonary therapies for PARDS.
Conclusions: These recommendations and statements about nonpulmonary treatments in PARDS are intended to promote optimization and consistency of care for patients with PARDS and identify areas of uncertainty requiring further investigation.
Competing Interests: Dr. Morrow’s institution received funding from the National Research Foundation of Southern Africa, EuroQual Group, and Society of Critical Care Medicine/Pediatric Critical Care Medicine; she received funding from the University of Cape Town. Dr. Nadkarni is an elected member of the Executive Committee (Council) of the Society of Critical care Medicine. The views presented are those of the author and do not represent the views of the SCCM organization. Dr. Curley’s institution received funding from the National Heart, Lung, and Blood Institute and the National Institute for Child Health and Human Development. The remaining authors have disclosed that they do not have any potential conflicts of interest.
(Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)