Early Use of Adjunctive Therapies for Pediatric Acute Respiratory Distress Syndrome: A PARDIE Study

Rowan, Courtney M.; Klein, Margaret J.; Hsing, Deyin D.; Dahmer, Mary K.; Spinella, Philip C.; Émériaud, Guillaume; Hassinger, Amanda; Piñeres-Olave, Byron Enrique; Flori, Heidi R.; Haileselassie, Bereketeab; López-Fernández, Yolanda M; Chima, Ranjit S.; Shein, Steven L.; Maddux, Aline B; Lillie, Jonathan; Izquierdo, Ledys; Kneyber, Martin C. J.; Smith, Lincoln; Khemani, Robinder G.; Thomas, Neal J.; Yehya, Nadir

doi:10.1164/rccm.201909-1807oc

Cited by 36 publications

(32 citation statements)

References 40 publications

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“…Thus, HFPV may be a promising alternative ventilator mode for its relative hemodynamic stability, relative to HFOV, even in subjects with significant hypoxemia. Similarly, rates of neuromuscular blockade use were lower in our HFPV cohort than in adult 15 or pediatric 17 HFOV cohorts, which may also be advantageous. A direct comparison of these two salvage modes of ventilation for refractory respiratory failure is warranted, with an assessment of both short‐term gas exchange as well as longer term patient‐centered outcomes.…”

Section: Discussionmentioning

confidence: 67%

“…This may be due to the fact that HFPV appears to be utilized earlier in refractory ARF than HFOV. In a large multicenter study, HFOV was started at a median OI of 25.7 (IQR: 16.7, 37.3), 17 relative to a pre‐HFPV median OI of 16.6 (IQR: 8.6, 26.9) in our cohort. Thus, some of the differences in rates of adverse effects between these modalities may be due to a lower severity of hypoxemia at the time of transition.…”

Section: Discussionmentioning

confidence: 99%

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High frequency percussive ventilation in pediatric acute respiratory failure

Butler

Dominick

Yehya

2020

Pediatric Pulmonology

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Objective: High frequency percussive ventilation (HFPV) is used in acute respiratory failure, but is poorly described in pediatrics. We aimed to describe the clinical characteristics, ventilator settings, and outcomes of a large pediatric cohort, and to determine predictors of who would benefit from HFPV. Hypothesis: Gas exchange 2 h after HFPV initiation predicts success. Design: Single center retrospective cohort study testing association between gas exchange 2 h after HFPV initiation with success, defined a priori. Patients: Intubated children on HFPV for ≥2 h from 2012 to 2018. Methods: We described indications, ventilator settings, and gas exchange immediately before, 2 h after, and at termination of HFPV. Univariate and multivariate regression tested association of oxygenation and ventilation after HFPV initiation with success. Areas under the receiver operating characteristic (AUROC) curve and adjusted odds ratios (aORs) were computed. Results: We performed 237 courses of HFPV in 193 children (22% non-survivors), of which 162 (68%) were successful. In univariate analysis, pH (AUROC, 0.65) and PCO 2 (AUROC, 0.66) 2 h after HFPV predicted success. In multivariate analysis, pH (aOR: 1.67 per 1 SD; 95% confidence interval [CI]: 1.19-2.35), PCO 2 (aOR: 0.49 per 1 SD; 95% CI: 0.31-0.79), and oxygenation index (aOR: 0.66 per 1 SD; 95% CI: 0.44-0.97) 2 h after HFPV initiation were associated with success. Conclusion: We describe the largest cohort of HFPV to date, with detailed description of indications and settings. Gas exchange after 2 h of HFPV was independently associated with success.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

High frequency percussive ventilation in pediatric acute respiratory failure

Butler

Dominick

Yehya

2020

Pediatric Pulmonology

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“…The benefit seen in adult patients led to a recommendation from the Pediatric Acute lung injury consensus conference to consider prone positioning in severe PARDS [ 15 ]. However, it appears that prone positioning may be under-utilized in PARDS for children treated in the United States [ 21 ]. This low frequency of prone positioning seen in this international study may be secondary to a negative randomized trial for prone positioning in pediatrics [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

The Use of a Kinetic Therapy Rotational Bed in Pediatric Acute Respiratory Distress Syndrome: A Case Series

et al. 2020

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Patients with acute respiratory distress syndrome (ARDS) commonly have dependent atelectasis and heterogeneous lung disease. Due to the heterogenous lung volumes seen, the application of positive end expiratory pressure (PEEP) can have both beneficial and deleterious effects. Alternating supine and prone positioning may be beneficial in ARDS by providing more homogenous distribution of PEEP and decreasing intrapulmonary shunt. In pediatrics, the pediatric acute lung injury and consensus conference (PALICC) recommended to consider it in severe pediatric ARDS (PARDS). Manually prone positioning patients can be burdensome in larger patients. In adults, the use of rotational beds has eased care of these patients. There is little published data about rotational bed therapy in children. Therefore, we sought to describe the use of a rotational bed in children with PARDS. We performed a retrospective case series of children who utilized a rotational bed as an adjunctive therapy for their PARDS. Patient data were collected and analyzed. Descriptive statistical analyses were performed and reported. Oxygenation indices (OI) pre- and post-prone positioning were analyzed. Twelve patients with PARDS were treated with a rotational bed with minimal adverse events. There were no complications noted. Three patients had malfunctioning of their arterial line while on the rotational bed. Oxygenation indices improved over time in 11 of the 12 patients included in the study while on the rotational bed. Rotational beds can be safely utilized in pediatric patients. In larger children with PARDS, where it may be more difficult to perform a manual prone position, use of a rotational bed can be considered a safe alternative.

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“…The management, especially in severe cases, includes all necessary measures to gain time. Considering that these therapies have a low level of evidence, they can be initiated if they have no major risks for the patient 29,37,38 . a) Negative cumulative balance Negative water balance is ideal in PARDS, as long as hemodynamic stability is preserved.…”

Section: Other Therapeutic Approachesmentioning

confidence: 99%

Pediatric acute respiratory distress syndrome: How to protect the lungs during mechanical ventilation?

Coronado-Munoz¹,

Escalante-Kanashiro²

2021

BMHIM

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Pediatric acute respiratory distress syndrome (PARDS) is a frequent diagnosis in critical care. This inflammatory process has different stages characterized by mild-to-severe hypoxia, and the management will vary according to the severity. New definitions for pediatric patients were published in 2015; new epidemiological evidence revising those definitions has helped understand the mortality associated with PARDS and the impact on ventilation. The strategies to protect the lungs during mechanical ventilation have been successful in reducing mortality and complications. In clinical situations where high levels of critical support are limited, other therapies with a lower level of evidence can be attempted to gain time without worsening the ongoing pulmonary injury. We offer a complete narrative revision of this syndrome, with the critical management of these patients as a priority.

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Early Use of Adjunctive Therapies for Pediatric Acute Respiratory Distress Syndrome: A PARDIE Study

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Cited by 36 publications

References 40 publications

High frequency percussive ventilation in pediatric acute respiratory failure

High frequency percussive ventilation in pediatric acute respiratory failure

The Use of a Kinetic Therapy Rotational Bed in Pediatric Acute Respiratory Distress Syndrome: A Case Series

Pediatric acute respiratory distress syndrome: How to protect the lungs during mechanical ventilation?

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