Noninvasive Respiratory Support for Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

医学 重症监护医学 鼻插管 梅德林 呼吸窘迫 呼吸衰竭 麻醉 外科 套管 政治学 法学
作者
Christopher L. Carroll,Natalie Napolitano,M. Pons,Narayan P. Iyer,Steven Kwasi Korang,Sandrine Essouri
出处
期刊:Pediatric Critical Care Medicine [Ovid Technologies (Wolters Kluwer)]
卷期号:24 (Supplement 1 2S): S135-S147 被引量:16
标识
DOI:10.1097/pcc.0000000000003165
摘要

To develop evidence-based recommendations for the Second Pediatric Acute Lung Injury Consensus Conference (PALICC) regarding the effectiveness of noninvasive respiratory support for pediatric acute respiratory distress syndrome (PARDS). These include consideration of the timing and duration of noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC), whether effectiveness varies by disease severity or by characteristics of treatment delivery, and best practices for the use of NIV.MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost).Searches included all studies involving the use of NIV or HFNC in children with PARDS or hypoxemic respiratory failure.Title/abstract review, full-text review, and data extraction using a standardized data extraction form.The Grading of Recommendations Assessment, Development, and Evaluation approach was used to identify and summarize evidence and develop recommendations. Out of 6,336 studies, we identified 187 for full-text review. Four clinical recommendations were generated, related to indications, timing and duration of NIV in patients with PARDS, predictors of NIV failure and need for intubation (signs and symptoms of worsening disease including pulse oximetry saturation/Fio2 ratio), and use of NIV in resource-limited settings. Six good practice statements were generated related to how and where to deliver NIV, the importance of trained experienced staff and monitoring, types of NIV interfaces, the use of sedation, and the potential complications of this therapy. One research statement was generated related to indications of HFNC in patients with PARDS.NIV is a widely used modality for the treatment of respiratory failure in children and may be beneficial in a subset of patients with PARDS. However, there needs to be close monitoring for worsening disease and NIV failure.
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