Abstract：
To develop evidence-based recommendations for the Second Pediatric Acute Lung Injury Consensus Conference (PALICC) regarding the effectiveness of noninvasive respiratory support for pediatric acute respiratory distress syndrome (PARDS). These include consideration of the timing and duration of noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC), whether effectiveness varies by disease severity or by characteristics of treatment delivery, and best practices for the use of NIV.
MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost).
Searches included all studies involving the use of NIV or HFNC in children with PARDS or hypoxemic respiratory failure.
Title/abstract review, full-text review, and data extraction using a standardized data extraction form.
The Grading of Recommendations Assessment, Development, and Evaluation approach was used to identify and summarize evidence and develop recommendations. Out of 6,336 studies, we identified 187 for full-text review. Four clinical recommendations were generated, related to indications, timing and duration of NIV in patients with PARDS, predictors of NIV failure and need for intubation (signs and symptoms of worsening disease including pulse oximetry saturation/Fio2 ratio), and use of NIV in resource-limited settings. Six good practice statements were generated related to how and where to deliver NIV, the importance of trained experienced staff and monitoring, types of NIV interfaces, the use of sedation, and the potential complications of this therapy. One research statement was generated related to indications of HFNC in patients with PARDS.
NIV is a widely used modality for the treatment of respiratory failure in children and may be beneficial in a subset of patients with PARDS. However, there needs to be close monitoring for worsening disease and NIV failure.
MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost).
Searches included all studies involving the use of NIV or HFNC in children with PARDS or hypoxemic respiratory failure.
Title/abstract review, full-text review, and data extraction using a standardized data extraction form.
The Grading of Recommendations Assessment, Development, and Evaluation approach was used to identify and summarize evidence and develop recommendations. Out of 6,336 studies, we identified 187 for full-text review. Four clinical recommendations were generated, related to indications, timing and duration of NIV in patients with PARDS, predictors of NIV failure and need for intubation (signs and symptoms of worsening disease including pulse oximetry saturation/Fio2 ratio), and use of NIV in resource-limited settings. Six good practice statements were generated related to how and where to deliver NIV, the importance of trained experienced staff and monitoring, types of NIV interfaces, the use of sedation, and the potential complications of this therapy. One research statement was generated related to indications of HFNC in patients with PARDS.
NIV is a widely used modality for the treatment of respiratory failure in children and may be beneficial in a subset of patients with PARDS. However, there needs to be close monitoring for worsening disease and NIV failure.
摘要：
目的：为第二届小儿急性肺损伤共识会议（PALICC）制定有关无创呼吸支持治疗小儿急性呼吸窘迫综合征（PARDS）有效性的循证建议。这些包括考虑无创通气（NIV）和高流量鼻插管（HFNC）的时机和持续时间，有效性是否因疾病严重程度或治疗交付特征而异，以及使用NIV的最佳实践。
方法：MEDLINE(Ovid)，Embase(Elsevier),和CINAHL完成（EBSCOhost）。
方法：搜索包括所有在PARDS或低氧性呼吸衰竭患儿中使用NIV或HFNC的研究。
方法：标题/摘要评论，全文回顾,和使用标准化的数据提取表单进行数据提取。
结果：建议评估的分级，发展,采用评估方法进行证据识别和总结，并提出建议。在6,336项研究中，我们确定了187个全文审查。产生了四项临床建议，与适应症有关，PARDS患者NIV的时间和持续时间，NIV失败和需要插管的预测因素（疾病恶化的体征和症状，包括脉搏血氧饱和度/Fio2比值），以及在资源有限的环境中使用NIV。就如何以及在哪里提供NIV，训练有素的经验丰富的工作人员和监测的重要性，NIV接口的类型，使用镇静剂，以及这种疗法的潜在并发症。产生了一项与PARDS患者的HFNC适应症相关的研究声明。
结论：NIV是一种广泛使用的治疗儿童呼吸衰竭的方法，可能对部分PARDS患者有益。然而,需要密切监测疾病恶化和NIV失败。
方法：MEDLINE(Ovid)，Embase(Elsevier),和CINAHL完成（EBSCOhost）。
方法：搜索包括所有在PARDS或低氧性呼吸衰竭患儿中使用NIV或HFNC的研究。
方法：标题/摘要评论，全文回顾,和使用标准化的数据提取表单进行数据提取。
结果：建议评估的分级，发展,采用评估方法进行证据识别和总结，并提出建议。在6,336项研究中，我们确定了187个全文审查。产生了四项临床建议，与适应症有关，PARDS患者NIV的时间和持续时间，NIV失败和需要插管的预测因素（疾病恶化的体征和症状，包括脉搏血氧饱和度/Fio2比值），以及在资源有限的环境中使用NIV。就如何以及在哪里提供NIV，训练有素的经验丰富的工作人员和监测的重要性，NIV接口的类型，使用镇静剂，以及这种疗法的潜在并发症。产生了一项与PARDS患者的HFNC适应症相关的研究声明。
结论：NIV是一种广泛使用的治疗儿童呼吸衰竭的方法，可能对部分PARDS患者有益。然而,需要密切监测疾病恶化和NIV失败。
