Editor's Choice, July 2018

Ozge Yilmaz, MD

Management of Acute Rrespiratory Distress Syndrome (ARDS) that carries high mortality especially in children requires experience and extensive knowledge of mechanical ventilation methods. Khemani et al has published a multi-center study in the current issue of American Journal of Respiratory and Critical Care Medicine about the results of not complying with ARDS Network protocol in management of pediatric acute respiratory distress syndrome (ARDS). They demonstrated that nearly one quarter of pediatric cases with ARDS were managed with lower positive end-expiratory pressure (PEEP) relative to the amount of FiO2 compared to the values recommended by ARDSnet. Moreover, these lower PEEP values were associated with nearly twice the mortality observed in patients managed with PEEP values at or above ARDSnet recommendations. Although further clinical trials are required this result warrants compliance to the PEEP/FiO2 tables in the ARDSNet to decraese mortality in pediatric ARDS.

(Khemani RG, Parvathaneni K, Yehya N, Bhalla AK, Thomas NJ, Newth CJL. Positive End-Expiratory Pressure Lower Than the ARDS Network Protocol Is Associated with Higher Pediatric Acute Respiratory Distress Syndrome Mortality. Am J Respir Crit Care Med. 2018 Jul 1;198(1):77-89. )