Approaches in the management of acute respiratory failure in children.
OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
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.
Priestley
Margaret A
MA
Department of Anesthesiology and Critical Care Medicine, The University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, 19104, USA. Priestly@email.chop.edu
Helfaer
Mark A
MA
D002648:Child; D004750:Enteral Nutrition / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D006612:High-Frequency Ventilation; D006801:Humans; D021061:Liquid Ventilation; D009569:Nitric Oxide / Q000378:metabolism; D016684:Prone Position / Q000502:physiology; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012128:Respiratory Distress Syndrome / Q000534:rehabilitation / Q000628:therapy*
D011663:Pulmonary Surfactants; D009569:Nitric Oxide