A focused issue on pediatric acute respiratory distress syndrome

This special issue of Annals of Translational Medicine presents a collection of review articles on pediatric acute respiratory distress syndrome (PARDS). Despite a trend toward improved outcomes over the past decade or so, PARDS still leads to significant morbidities and mortality (1-3). This collection of review articles provides a comprehensive overview on this important disease in the pediatric critical care environment. While a full review of PARDS is well beyond the goals of this issue, we have attempted to focus on important topics that go beyond the routine management strategies previously reported.

The collection begins with a description of the contemporary epidemiology of PARDS (4). Translational work in PARDS provides important insights into the disease pathophysiology. Three reviews that focus on this aspect highlights the potential of translational work in future approaches in diagnosis, prognostication and treatment of PARDS (5-7).

The cornerstone of management of PARDS, of course, remains mechanical ventilation (MV). As there are comprehensive review articles on this particular aspect of management of children with PARDS, we have chosen not to focus on this area. Thus, we refer readers to these articles (8,9). However, as MV can be a double-edged sword, in this collection we included a discussion on ventilator-induced lung injury (10).

This issue provides a more in-depth discussion on concurrent supportive management of children with PARDS—the utility of ultrasonography, role of nutrition, sedation, corticosteroids, and blood transfusion in these children (11-15). Because extracorporeal life support is increasingly utilized in PARDS, we included a discussion on the use of extracorporeal membrane oxygenation (ECMO) in children (16). Finally, we end the series with a discussion on what we foresee for future studies on PARDS (17,18).

We hope that you will enjoy this collection of articles that is authored by PICU practitioners across many regions in the world. This provides for different perspectives of management in this disease around the world. We sincerely hope that future monographs on important PICU topics will have such a diversity in input and opinions.

Acknowledgments

None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

References

1. Khemani RG, Smith L, Lopez-Fernandez YM, et al. Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. Lancet Respir Med 2019;7:115-28. [Crossref] [PubMed]
2. Wong JJ, Jit M, Sultana R, et al. Mortality in Pediatric Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis. J Intensive Care Med 2019;34:563-71. [Crossref] [PubMed]
3. Schouten LR, Veltkamp F, Bos AP, et al. Incidence and Mortality of Acute Respiratory Distress Syndrome in Children: A Systematic Review and Meta-Analysis. Crit Care Med 2016;44:819-29. [PubMed]
4. Beltramo F, Khemani RG. Definition and global epidemiology of pediatric acute respiratory distress syndrome. Ann Transl Med 2019;7:502.
5. Yehya N. Lessons learned in acute respiratory distress syndrome from the animal laboratory. Ann Transl Med 2019;7:503.
6. Wong JJM, Leong JY, Lee JH, et al. Insights into the immuno-pathogenesis of acute respiratory distress syndrome. Ann Transl Med 2019;7:504.
7. Carlton EF, Flori HR. Biomarkers in pediatric acute respiratory distress syndrome. Ann Transl Med 2019;7:505.
8. Rimensberger PC, Cheifetz IM. Pediatric Acute Lung Injury Consensus Conference Group. Ventilatory support in children with pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015;16:S51-60. [Crossref] [PubMed]
9. Kneyber MCJ, de Luca D, Calderini E, et al. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Med 2017;43:1764-80. [Crossref] [PubMed]
10. Koopman AA, de Jager P, Blokpoel RGT, et al. Ventilator-induced lung injury in children: a reality? Ann Transl Med 2019;7:506.
11. Potter SK, Griksaitis MJ. The role of point-of-care ultrasound in pediatric acute respiratory distress syndrome: emerging evidence for its use. Ann Transl Med 2019;7:507.
12. Monteverde-Fernández N, Cristiani F, McArthur J, et al. Steroids in pediatric acute respiratory distress syndrome. Ann Transl Med 2019;7:508.
13. Rosenberg L, Traube C. Sedation strategies in children with pediatric acute respiratory distress syndrome (PARDS). Ann Transl Med 2019;7:509.
14. Iyer R, Bansal A. What do we know about optimal nutritional strategies in children with pediatric acute respiratory distress syndrome? Ann Transl Med 2019;7:510.
15. François T, Emeriaud G, Karam O, et al. Transfusion in children with acute respiratory distress syndrome. Ann Transl Med 2019;7:511.
16. Erickson S. Extra-corporeal membrane oxygenation in paediatric acute respiratory distress syndrome: overrated or underutilized? Ann Transl Med 2019;7:512.
17. Lee SW, Loh SW, Ong C, et al. Pertinent clinical outcomes in pediatric survivors of pediatric acute respiratory distress syndrome (PARDS): a narrative review. Ann Transl Med 2019;7:513.
18. Allareddy V, Cheifetz IM. Clinical trials and future directions in pediatric acute respiratory distress syndrome. Ann Transl Med 2019;7:514.

Jan Hau Lee

Martin Kneyber

Ira M. Cheifetz