Management of oxygenation in pediatric acute hypoxemic respiratory failure

The prognosis for patients with acute respiratory distress syndrome (ARDS) in adults and children has improved since its formal acceptance as a clinic al entity in 1967. Because acute hypoxemic respiratory failure is the hallm ark of acute lung injury and ARDS, the management of oxygenation is crucial . Physicians managing pediatric patients with acute lung injury or ARDS are faced with a complex array of options influencing oxygenation. Certain tre atment strategies can influence clinical outcomes, such as a lung-protectiv e ventilation strategy that specifies a low tidal volume (6 mL/kg) and a pl ateau pressure limit (30 cm H2O) (Acute Respiratory Distress Network, N Eng l J Med 2000;342:1301-1308). Other lung-protective strategies such as diffe rent levels of positive end-expiratory pressure, altered inspiratory:expira tory ratios, recruitment maneuvers, prone positioning, and extraneous gases or drugs may impact clinical outcomes but require further clinical study. This paper reviews state-of-the-art strategies on the management of oxygena tion in acute hypoxemic respiratory failure and attempts to guide pediatric pulmonologists in managing children with respiratory failure. (C) 2001 Wil ey-Liss, Inc.