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Approaches in the management of acute respiratory failure in children

Priestley, Margaret A; Helfaer, Mark A

Current Opinion in Pediatrics: June 2004 - Volume 16 - Issue 3 - p 293-298
doi: 10.1097/01.mop.0000126602.23949.48

Purpose of review Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are conditions that are associated with significant morbidity and mortality in children. There have been no advances in preventing ARDS, but this review highlights strategies directed at minimizing ventilator-induced lung injury and other new adjunctive therapies in the care of these patients.

Recent findings High-frequency oscillatory ventilation, airway pressure release ventilation, and partial liquid ventilation are potential protective ventilatory modes for children with ALI or ARDS. Recruitment maneuvers, prone positioning, and kinetic therapy are all reported to improve oxygenation by opening the lung while positive end-expiratory pressure maintains functional residual capacity. Inhaled nitric oxide and surfactant are used to reduce inspired oxygen concentration and facilitate gas exchange, but their efficacy in ARDS continues to be investigated. Also, early investigations suggest that a specialized enteral formula can be a useful adjunctive therapy by reducing lung inflammation and improving oxygenation. When mechanical ventilation and adjunctive therapies fail, extracorporeal life support continues to be used as a rescue therapy.

Summary It is likely that a combination of these therapies will maximize treatment and clinical outcomes in the future, but the only way that will be proven is through large controlled clinical trials in pediatric patients.

Department of Anesthesiology and Critical Care Medicine and Pediatrics, The University of Pennsylvania School of Medicine, The Children’s Hospital of Philadelphia, Pennsylvania, USA

Correspondence to Margaret Priestley, MD, Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, 9th Floor, Room 9329, Philadelphia, PA 19104, USA E-mail:

© 2004 Lippincott Williams & Wilkins, Inc.