Advances in the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome: An Overview of PALICC-2 Guidelines

Abstract This review article presents a comprehensive overview of the advancements in diagnosis and management of pediatric acute respiratory distress syndrome (PARDS) as delineated in the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines published in 2023. The manuscript revisits the initial definition of acute respiratory distress syndrome (ARDS) and the nuanced distinctions between ARDS and PARDS to provide a foundational understanding. An approach algorithm for PARDS has been developed to improve the precision of disease detection. Central to the PALICC-2 updates are the new diagnostic criteria, which incorporate the use of oxygenation indices such as the PaO 2 /FiO 2 ratio, SpO 2 /FiO 2 ratio, the oxygen index (OI), and the oxygen saturation index (OSI) for stratifying the severity of PARDS in patients on invasive and noninvasive ventilation. Notably, the guidelines introduce “possible PARDS” and “at risk for PARDS” to assist in early recognition and intervention. For managing PARDS, PALICC-2 emphasizes on using a lung-protective ventilation bundle and fine-tuning positive end-expiratory pressure (PEEP) according to the ARDS Network’s lower PEEP/higher FiO 2 table. Ancillary management strategies, including the judicious use of extracorporeal membrane oxygenation (ECMO) and neuromuscular blockade, are also discussed. Due to insufficient evidence for supporting their efficacy, the guidelines advise against the routine use of therapies such as recruitment maneuvers, inhalation of nitric oxide, and corticosteroids. Specific follow-up programs are recommended in children with PARDS. In conclusion, the PALICC-2 guidelines offer an essential update to improve outcomes for pediatric patients with ARDS by promoting a strategic approach to diagnosis and evidence-based management practices. This review highlights the critical aspects of these guidelines, thereby aiding clinicians in effectively caring for patients afflicted with PARDS.