Tamburro Robert F, Kneyber Martin C J
1Department of Pediatrics and Public Health Sciences, Division of Critical Care Medicine, Pennsylvania State University College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA. 2Department of Paediatrics, Division of Paediatric Intensive Care, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 3Critical care, Anaesthesiology, Perioperative Medicine & Emergency Medicine (CAPE), University of Groningen, Groningen, The Netherlands.
Pediatr Crit Care Med. 2015 Jun;16(5 Suppl 1):S61-72. doi: 10.1097/PCC.0000000000000434.
To provide an overview of the current literature on pulmonary-specific therapeutic approaches to pediatric acute respiratory distress syndrome to determine recommendations for clinical practice and/or future research.
PubMed, EMBASE, CINAHL, SCOPUS, and the Cochrane Library were searched from inception until January 2013 using the following keywords in various combinations: ARDS, treatment, nitric oxide, heliox, steroids, surfactant, etanercept, prostaglandin therapy, inhaled beta adrenergic receptor agonists, N-acetylcysteine, ipratroprium bromide, dornase, plasminogen activators, fibrinolytics or other anticoagulants, and children. No language restrictions were applied. References from identified articles were searched for additional publications.
All clinical studies pertaining to pulmonary-specific therapeutic approaches to pediatric acute respiratory distress syndrome were reviewed. If clinical pediatric data were sparse or unavailable, the findings from studies of adult acute respiratory distress syndrome and animal models that might be relevant to pediatric acute respiratory distress syndrome were examined.
All relevant studies were reviewed and pertinent data abstracted.
Over the course of three international meetings, the pertinent findings of the literature review were discussed by a panel of 24 experts in the field representing 21 academic institutions and 8 countries. Recommendations developed and the supporting literature were distributed to all panel members without a conflict of interest and were scored by using the Research ANd Development/University of California, Los Angeles Appropriateness method. The modified Delphi approach was used as the methodology to achieve consensus among the panel.
Overall, the routine use of surfactant, inhaled nitric oxide, glucocorticoids, prone positioning, endotracheal suctioning, and chest physiotherapy cannot be recommended. Inhaled nitric oxide should only be used for patients with documented pulmonary hypertension and/or right ventricular failure. Prone positioning may be considered in patients with severe pediatric acute respiratory distress syndrome. Future studies are definitely warranted to establish the role, if any, of these ancillary treatment modalities in pediatric acute respiratory distress syndrome.
综述目前关于小儿急性呼吸窘迫综合征肺部特异性治疗方法的文献，以确定临床实践和/或未来研究的建议。
从创刊至2013年1月，使用以下关键词的各种组合在PubMed、EMBASE、CINAHL、SCOPUS和Cochrane图书馆进行检索：急性呼吸窘迫综合征、治疗、一氧化氮、氦氧混合气、类固醇、表面活性剂、依那西普、前列腺素治疗、吸入性β肾上腺素能受体激动剂、N - 乙酰半胱氨酸、异丙托溴铵、多奈哌齐、纤溶酶原激活剂、纤溶剂或其他抗凝剂以及儿童。不设语言限制。检索已识别文章的参考文献以获取更多出版物。
对所有关于小儿急性呼吸窘迫综合征肺部特异性治疗方法的临床研究进行综述。如果临床儿科数据稀少或不可用，则检查与小儿急性呼吸窘迫综合征可能相关的成人急性呼吸窘迫综合征研究和动物模型的结果。
对所有相关研究进行综述并提取相关数据。
在三次国际会议期间，由来自21个学术机构和8个国家的24位该领域专家组成的小组讨论了文献综述的相关结果。制定的建议及支持文献分发给所有无利益冲突的小组成员，并使用研究与发展/加利福尼亚大学洛杉矶分校适宜性方法进行评分。采用改良的德尔菲法作为达成小组共识的方法。
总体而言，不建议常规使用表面活性剂、吸入一氧化氮、糖皮质激素、俯卧位通气、气管内吸引和胸部物理治疗。吸入一氧化氮仅应用于有记录的肺动脉高压和/或右心室衰竭患者。对于严重小儿急性呼吸窘迫综合征患者可考虑俯卧位通气。未来肯定需要进行研究以确定这些辅助治疗方式在小儿急性呼吸窘迫综合征中的作用（若有）。
