In this World Shared Practice Forum Podcast, Dr. Martin Kneyber discusses the implementation of the PALICC-2 guidelines in bedside monitoring and management of pediatric acute respiratory distress syndrome (PARDS). He shares insights on how the concepts of positive end-expiratory pressure (PEEP), driving pressure, patient self-inflicted lung injury (P-SILI), and the use of non-invasive ventilation are translated to the bedside management of PARDS.

LEARNING OBJECTIVES

- Explain the concept of driving pressure and its significance in the management of pediatric acute lung injury

- Identify the potential benefits and drawbacks of neuromuscular blockade in pediatric acute lung injury patients

- Describe the concept of non-invasive ventilation in the management of acute respiratory failure in pediatric patients, including its potential benefits, limitations, and challenges in implementation

AUTHORS

Martin Kneyber MD, PhD, FCCM

Chief of the Division of Paediatric Critical Care Medicine

Beatrix Children’s Hospital

University Medical Center Groningen, Groningen, the Netherlands

Jeffrey Burns MD, MPH

Chief and Shapiro Chair, Division of Critical Care Medicine; Executive Chair, International Health Services

Senior Associate in Critical Care Medicine; Department of Anesthesiology, Critical Care and Pain Medicine

Boston Children's Hospital

Professor of Anesthesia

Harvard Medical School

DATES

Initial Publication Date: February 26, 2024.

ARTICLES REFERENCED

00:58 https://pubmed.ncbi.nlm.nih.gov/36661420/

Emeriaud G, López-Fernández YM, Iyer NP, et al. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2). Pediatr Crit Care Med. 2023;24(2):143-168.

01:46 https://pubmed.ncbi.nlm.nih.gov/29373802/

Khemani RG, Parvathaneni K, Yehya N, Bhalla AK, Thomas NJ, Newth CJL. Positive End-Expiratory Pressure Lower Than the ARDS Network Protocol Is Associated with Higher Pediatric Acute Respiratory Distress Syndrome Mortality. Am J Respir Crit Care Med. 2018;198(1):77-89.

02:53 https://pubmed.ncbi.nlm.nih.gov/30361119/

Khemani RG, Smith L, Lopez-Fernandez YM, et al. Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study [published correction appears in Lancet Respir Med. 2018 Nov 13;:] [published correction appears in Lancet Respir Med. 2019 Mar;7(3):e12]. Lancet Respir Med. 2019;7(2):115-128.

07:45 https://pubmed.ncbi.nlm.nih.gov/25693014/

Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372(8):747-755.

07:49 https://pubmed.ncbi.nlm.nih.gov/36661438/

Yehya N, Smith L, Thomas NJ, et al. Definition, Incidence, and Epidemiology of Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2023;24(12 Suppl 2):S87-S98.

18:09 https://pubmed.ncbi.nlm.nih.gov/20843245/

Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363(12):1107-1116.

18:27 https://pubmed.ncbi.nlm.nih.gov/27779896/

Huang DT, Angus DC, Moss M, et al. Design and Rationale of the Reevaluation of Systemic Early Neuromuscular Blockade Trial for Acute Respiratory Distress Syndrome. Ann Am Thorac Soc. 2017;14(1):124-133.

19:26 https://pubmed.ncbi.nlm.nih.gov/27748627/

Doorduin J, Nollet JL, Roesthuis LH, et al. Partial Neuromuscular Blockade during Partial Ventilatory Support in Sedated Patients with High Tidal Volumes. Am J Respir Crit Care Med. 2017;195(8):1033-1042.

Kneyber MCJ, O’Hara JE, Burns JP. Bedside Implementation of the PALICC-2 Guidelines. 2/2024. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/bedside-implementation-of-the-palicc-2-guidelines-by-m-kneyber-openpediatrics.