Acute Respiratory Distress Syndrome in Children

A wide array of insults can lead to respiratory failure in children. Its most severe form – acute respiratory distress syndrome (ARDS) – also occurs in children. The incidence of ARDS in children varies between two and ten cases per 100,000 per year, with mortality rates ranging between 15 and 75%. In 2015, the Pediatric Acute Lung Injury Consensus Conference (PALICC) developed a paediatric – specific definition for ARDS in children. The new definition of paediatric ARDS (PARDS) mirrors the Berlin definition of ARDS in adults, with the exception of chest radiograph appearances and the metrics for oxygenation. The diagnosis of PARDS requires the need for at least one consolidation on chest radiograph rather than mandating the need for bilateral consolidations. Also, the oxygenation index is used instead of the PaO2/FiO2. To date, much of the clinical approach to paediatric ARDS is based on data from adult literature and personal experiences. This paucity in data relates to ventilatory and supportive management, including the use of lung-protective ventilation strategies, inhaled nitric oxide (iNO), corticosteroids and exogenous surfactant. Various avenues of research are much needed to provide a scientific basis to manage paediatric ARDS and to understand its long-term outcome. This chapter discusses the current understanding of PARDS and its similarities and differences with adults