Pediatric ARDS Management Guidelines

Ventilation Strategies

The American Thoracic Society suggests lung-protective ventilation with low tidal volumes (4-8 ml/kg predicted body weight) and limited plateau pressures as the cornerstone of PARDS management 1
Higher PEEP is suggested for moderate to severe PARDS, though the exact level has not been determined in pediatric patients 2, 1
The Society of Critical Care Medicine recommends using the ARDS-network PEEP to FiO₂ grid with caution in PARDS studies due to potential adverse hemodynamic effects in children with septic shock 2

The Surviving Sepsis Campaign suggests prone positioning for children with severe PARDS for at least 12 hours per day 2, 1
The Society of Critical Care Medicine suggests neuromuscular blockade in severe PARDS, typically for 24-48 hours after ARDS onset 2, 3
Inhaled nitric oxide is not recommended for routine use but may be considered as rescue therapy in refractory hypoxemia by the American Thoracic Society 2, 3

The American College of Critical Care Medicine recommends avoiding excessive fluid administration, which can worsen pulmonary edema and outcomes in pediatric patients with PARDS 1, 4