Recent Advances in Pediatric Acute Respiratory Distress Syndrome (PARDS)

Abstract

The purpose of this review is to summarize the recent literature on pediatric acute respiratory distress syndrome (PARDS). This review will focus on, but not be limited to, literature using the recent definition of PARDS established by the Pediatric Acute Lung Injury Consensus Conference (PALICC) group in 2015. Mortality rates for PARDS have recently decreased to 10–15%. Clinical trials in PARDS have (1) emphasized the relative importance of early oxygenation in predicting mortality; (2) suggested a role for protocolized sedation in patients managed with extracorporeal membrane oxygenation (ECMO); (3) found no mortality benefit to high-frequency oscillatory ventilation (HFOV), exogenous surfactant, or corticosteroids; and (4) suggested biomarkers and whole exome sequencing as methods for personalizing management. Recent laboratory studies have suggested differences in responsiveness to high tidal volume injury in juvenile rodents. The near future of PARDS management could include earlier risk stratification of patients by (1) oxygenation within 24 h of PARDS diagnosis and (2) use of biomarkers and subphenotypes. Despite challenges in performing clinical trials in children, the PALICC definition presents an opportunity to explore these and more research questions in PARDS separately from adult cohorts.