title: Pulmonary specific ancillary treatment for pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference.
abstract: OBJECTIVE
  To provide an overview of the current literature on pulmonary-specific therapeutic approaches to pediatric acute respiratory distress syndrome to determine recommendations for clinical practice and/or future research.
  
  
  METHODS
  PubMed, EMBASE, CINAHL, SCOPUS, and the Cochrane Library were searched from inception until January 2013 using the following keywords in various combinations: ARDS, treatment, nitric oxide, heliox, steroids, surfactant, etanercept, prostaglandin therapy, inhaled beta adrenergic receptor agonists, N-acetylcysteine, ipratroprium bromide, dornase, plasminogen activators, fibrinolytics or other anticoagulants, and children. No language restrictions were applied. References from identified articles were searched for additional publications.
  
  
  METHODS
  All clinical studies pertaining to pulmonary-specific therapeutic approaches to pediatric acute respiratory distress syndrome were reviewed. If clinical pediatric data were sparse or unavailable, the findings from studies of adult acute respiratory distress syndrome and animal models that might be relevant to pediatric acute respiratory distress syndrome were examined.
  
  
  METHODS
  All relevant studies were reviewed and pertinent data abstracted.
  
  
  RESULTS
  Over the course of three international meetings, the pertinent findings of the literature review were discussed by a panel of 24 experts in the field representing 21 academic institutions and 8 countries. Recommendations developed and the supporting literature were distributed to all panel members without a conflict of interest and were scored by using the Research ANd Development/University of California, Los Angeles Appropriateness method. The modified Delphi approach was used as the methodology to achieve consensus among the panel.
  
  
  CONCLUSIONS
  Overall, the routine use of surfactant, inhaled nitric oxide, glucocorticoids, prone positioning, endotracheal suctioning, and chest physiotherapy cannot be recommended. Inhaled nitric oxide should only be used for patients with documented pulmonary hypertension and/or right ventricular failure. Prone positioning may be considered in patients with severe pediatric acute respiratory distress syndrome. Future studies are definitely warranted to establish the role, if any, of these ancillary treatment modalities in pediatric acute respiratory distress syndrome.
authors.affiliation: 1Department of Pediatrics and Public Health Sciences, Division of Critical Care Medicine, Pennsylvania State University College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA. 2Department of Paediatrics, Division of Paediatric Intensive Care, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 3Critical care, Anaesthesiology, Perioperative Medicine & Emergency Medicine (CAPE), University of Groningen, Groningen, The Netherlands.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Tamburro
authors.forename: Martin C J
authors.initials: MC
authors.lastname: Kneyber
mesh_terms: D000208:Acute Disease; D003697:Delphi Technique; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D009569:Nitric Oxide / Q000627:therapeutic use; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012196:Review Literature as Topic; D013396:Suction / Q000379:methods
chemical_list: D005938:Glucocorticoids; D011663:Pulmonary Surfactants; D009569:Nitric Oxide