Jennifer A Blumenthal1,2, Melody G Duvall1. 1. Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School. 2. Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Abstract
PURPOSE OF REVIEW: Severe Acute Respiratory Syndrome Coronavirus 2 presents as symptomatic coronavirus disease 2019 (COVID-19) disease in susceptible patients. Severe pediatric COVID-19 disease is rare, limiting potential data accumulation on associated respiratory failure in children. Pediatric intensivists and pulmonologists managing COVID-19 patients look to adult guidelines and pediatric-specific consensus statements to guide management. The purpose of this article is to review the current literature and recommended strategies for the escalation of noninvasive and invasive respiratory support for acute respiratory failure associated with COVID-19 disease in children. RECENT FINDINGS: There are no prospective studies comparing COVID-19 treatment strategies in children. Adult and pediatric ventilation management interim guidance is based on evidence-based guidelines in non-COVID acute respiratory distress syndrome, with considerations of (1) noninvasive positive pressure ventilation versus high-flow nasal cannula and (2) high versus lower positive end expiratory pressure strategies related to lung compliance and potential lung recruitability. SUMMARY: Management of acute respiratory failure from COVID-19 requires individualized titration of noninvasive and invasive ventilation modalities with consideration of preserved or compromised pulmonary compliance. Research regarding best practices in the management of pediatric severe COVID-19 with respiratory failure is lacking and is acutely needed as the pandemic surges and vaccination of the pediatric population will be delayed compared to adults.
PURPOSE OF REVIEW: Severe Acute Respiratory Syndrome Coronavirus 2 presents as symptomatic coronavirus disease 2019 (COVID-19) disease in susceptible patients. Severe pediatric COVID-19 disease is rare, limiting potential data accumulation on associated respiratory failure in children. Pediatric intensivists and pulmonologists managing COVID-19 patients look to adult guidelines and pediatric-specific consensus statements to guide management. The purpose of this article is to review the current literature and recommended strategies for the escalation of noninvasive and invasive respiratory support for acute respiratory failure associated with COVID-19 disease in children. RECENT FINDINGS: There are no prospective studies comparing COVID-19 treatment strategies in children. Adult and pediatric ventilation management interim guidance is based on evidence-based guidelines in non-COVID acute respiratory distress syndrome, with considerations of (1) noninvasive positive pressure ventilation versus high-flow nasal cannula and (2) high versus lower positive end expiratory pressure strategies related to lung compliance and potential lung recruitability. SUMMARY: Management of acute respiratory failure from COVID-19 requires individualized titration of noninvasive and invasive ventilation modalities with consideration of preserved or compromised pulmonary compliance. Research regarding best practices in the management of pediatric severe COVID-19 with respiratory failure is lacking and is acutely needed as the pandemic surges and vaccination of the pediatric population will be delayed compared to adults.
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Authors: Holger J Schünemann; Joanne Khabsa; Karla Solo; Assem M Khamis; Romina Brignardello-Petersen; Amena El-Harakeh; Andrea Darzi; Anisa Hajizadeh; Antonio Bognanni; Anna Bak; Ariel Izcovich; Carlos A Cuello-Garcia; Chen Chen; Ewa Borowiack; Fatimah Chamseddine; Finn Schünemann; Gian Paolo Morgano; Giovanna E U Muti-Schünemann; Guang Chen; Hong Zhao; Ignacio Neumann; Jan Brozek; Joel Schmidt; Layal Hneiny; Leila Harrison; Marge Reinap; Mats Junek; Nancy Santesso; Rayane El-Khoury; Rebecca Thomas; Robby Nieuwlaat; Rosa Stalteri; Sally Yaacoub; Tamara Lotfi; Tejan Baldeh; Thomas Piggott; Yuan Zhang; Zahra Saad; Bram Rochwerg; Dan Perri; Eddy Fan; Florian Stehling; Imad Bou Akl; Mark Loeb; Paul Garner; Stephen Aston; Waleed Alhazzani; Wojciech Szczeklik; Derek K Chu; Elie A Akl Journal: Ann Intern Med Date: 2020-05-22 Impact factor: 25.391
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