Conventional Mechanical Ventilation in Pediatric Acute Respiratory Distress Syndrome

Abstract

In 1967, Ashbaugh and colleagues described a group of predominantly adult patients with various underlying conditions who developed a peculiar form of respiratory failure. Regardless of the inciting etiology, these patients shared a common rapid progression to respiratory failure with hypoxemia, diffuse infiltrates on chest radiographs, decreased lung compliance, and decreased functional residual capacity, requiring the application of positive end-expiratory pressure (PEEP) to improve oxygenation. This condition, which we now know as the acute respiratory distress syndrome (ARDS), was based on somewhat vague diagnostic criteria and was not specific enough to exclude other medical conditions with similar manifestations. Our understanding of ARDS has increased greatly during the past five decades. ARDS definitions and diagnostic criteria have also evolved over time, including the Murray Lung Injury Score (1988), the American-European Consensus Conference Definition (1994), and the Berlin Definition (2012) put forth jointly by the European Society of Intensive Care Medicine (ESICM) and the Society of Critical Care Medicine (SCCM). Each of these definitions represented a step forward in delineating this important diagnosis, yet the applicability of these adult-centric definitions had significant limitations for children since they did not consider ARDS factors germane to the pediatric patient. The lack of a pediatric-specific ARDS definition, coupled with a rapidly growing body of literature on children with acute hypoxemic respiratory failure, led an expert panel to assemble the Pediatric Acute Lung Injury Consensus Conference (PALICC, 2015) and put forth the first definition of pediatric ARDS (PARDS). This definition represented a major step forward for those involved in PARDS diagnosis, treatment, and research. It provided the framework that would allow for comparisons across multiple institutions, helped define the actual worldwide prevalence of this condition, and clarified the role of various treatment modalities and their impact on outcomes. This textbook will provide a comprehensive review of the available and emerging science related to PARDS, discuss state-of-the-art treatment modalities and strategies, and reflect on clinical outcomes for this important condition. The various chapters were written by established experts in the field of PARDS, many of whom participated in the original PALICC effort.