Paediatric acute respiratory distress syndrome: progress over the past decade
Acute respiratory distress syndrome (ARDS) is a clinical condition that poses significant threat to patients of all age groups. It involves severe inflammation of pulmonary tissues and results in hypoxemia. In children, pneumonia remains the major cause of paediatric ARDS (PARDS) in contrast to sepsis in adults. In this article, we provide a narrative review on the following specific aspects of PARDS over the past decade: (I) the adoption of the new PARDS and neonatal ARDS definitions; (II) novel biomarkers in risk stratification of PARDS; (III) ventilatory strategies in PARDS, with particular attention to positive end-expiratory pressure (PEEP), tidal volumes and driving pressures; and (IV) personalized medicine in PARDS. In recent years, attention has been given to the paediatric population with the establishment of the criteria for children with ARDS. This new PARDS definition subsequently led to a proposal of a definition of ARDS in the neonatal population. Studies in PARDS is sparse and clinical practice are mostly extrapolated from findings in adult studies. The use of PEEP has been part of the standard of treatment in adults and children with ARDS. Initially used to improve oxygenation, it is now commonly utilized now as a lung protective measure by reducing the shear force from repetitive alveolar opening and closing. It is uncertain at present whether high PEEP is beneficial in PARDS but adult studies have shown no significant differences in mortality rates. Biomarkers have been studied extensively in adults and children but no particular biomarker has been found to be robust in predicting outcomes from PARDS. However, they do pave the way for more personalized medicine to take place. In fact, current strategies in ARDS treatment seems to be directed towards more precision-based approaches. Further research in stratification of management in PARDS is urgently required.