• Courtney M Rowan, Adrienne G Randolph, Narayan Prabhu Iyer, Steven Kwasi Korang, KneyberMartin C JMCJDepartment of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.Critical care, Anesthesiology, Peri-operati, and Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.
• Department of Pediatrics, Division of Critical Care Medicine, Indiana University School of medicine, Riley Hospital for Children at IU Health, Indianapolis, IN.
• Pediatr Crit Care Me. 2023 Feb 1; 24 (12 Suppl 2): S99S111S99-S111.

ObjectivesWe conducted an updated review of the literature on pulmonary-specific ancillary therapies for pediatric acute respiratory distress syndrome (PARDS) to provide an update to the Pediatric Acute Lung Injury Consensus Conference recommendations and statements about clinical practice and research.Data SourcesMEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost).Study SelectionSearches were limited to children, PARDS or hypoxic respiratory failure and overlap with pulmonary-specific ancillary therapies.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 evidence and develop recommendations. Twenty-six studies were identified for full-text extraction. Four clinical recommendations were generated, related to use of inhaled nitric oxide, surfactant, prone positioning, and corticosteroids. Two good practice statements were generated on the use of routine endotracheal suctioning and installation of isotonic saline prior to endotracheal suctioning. Three research statements were generated related to: the use of open versus closed suctioning, specific methods of airway clearance, and various other ancillary therapies.ConclusionsThe evidence to support or refute any of the specific ancillary therapies in children with PARDS remains low. Further investigation, including a focus on specific subpopulations, is needed to better understand the role, if any, of these various ancillary therapies in PARDS.Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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