• Analía Fernández, Vicent Modesto, Peter C Rimensberger, Steven K Korang, Narayan P Iyer, Ira M Cheifetz, and Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.
• Pediatric Intensive Care Unit, Emergency Department, Hospital General de Agudos "C. Durand" Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.
• Pediatr Crit Care Me. 2023 Feb 1; 24 (12 Suppl 2): S61S75S61-S75.

ObjectiveTo provide evidence for the Second Pediatric Acute Lung Injury Consensus Conference updated recommendations and consensus statements for clinical practice and future research on invasive mechanical ventilation support of patients with pediatric acute respiratory distress syndrome (PARDS).Data SourcesMEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost).Study SelectionWe included clinical studies of critically ill patients undergoing invasive mechanical ventilation for PARDS, January 2013 to April 2022. In addition, meta-analyses and systematic reviews focused on the adult acute respiratory distress syndrome population were included to explore new relevant concepts (e.g., mechanical power, driving pressure, etc.) still underrepresented in the contemporary pediatric literature.Data ExtractionTitle/abstract review, full text review, and data extraction using a standardized data collection form.Data SynthesisThe Grading of Recommendations Assessment, Development and Evaluation approach was used to identify and summarize relevant evidence and develop recommendations, good practice statements and research statements. We identified 26 pediatric studies for inclusion and 36 meta-analyses or systematic reviews in adults. We generated 12 recommendations, two research statements, and five good practice statements related to modes of ventilation, tidal volume, ventilation pressures, lung-protective ventilation bundles, driving pressure, mechanical power, recruitment maneuvers, prone positioning, and high-frequency ventilation. Only one recommendation, related to use of positive end-expiratory pressure, is classified as strong, with moderate certainty of evidence.ConclusionsLimited pediatric data exist to make definitive recommendations for the management of invasive mechanical ventilation for patients with PARDS. Ongoing research is needed to better understand how to guide best practices and improve outcomes for patients with PARDS requiring invasive mechanical ventilation.Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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