TABLE 9.
Synthesis of the Second Pediatric Acute Lung Injury Consensus Conference Research Recommendations
| Activity | Research Neededa |
|---|---|
| Screening, diagnosis, and monitoring | |
| Diagnosis | Adult vs pediatric age-group comparison in pediatric acute respiratory distress syndrome progression and outcome (2.2) |
| Trajectory of illness using standardized minimal datasets and operational definitions (2.4.1) | |
| Diagnostic utility of Second Pediatric Acute Lung Injury Consensus Conference definition in RLS (11.3) | |
| Collaborative research networks to include RLS sites (11.4) | |
| Biomarker | Biomarker and genetic insight into pathophysiology (2.3.1) |
| Molecular phenotype and endotype studies (2.3.2) | |
| Data science | Collaborative data science (10.4) |
| Development of generalizable electronic tools (10.5) | |
| MV and cardiovascular system monitoring | |
| Endotracheal tube | Standardize spontaneous breathing trial and extubation readiness test in studies (6.4.2) |
| MV bundle | Closed vs open suctioning (4.4.2); methods and populations for airway clearance (4.5) |
| MV type | Studies of ventilator modes (3.1), studies of high-flow nasal cannula (7.4), studies needed inclusive of RLS (11.8) |
| Vt | Use of protocols and definitions in studies measuring Vt, peak inspiratory pressure, plateau pressure, positive end-expiratory pressure, mean airway pressure (2.4.2); use of mechanical power calculations (3.7); use of monitoring loops, compliance, resistance, strain-stress, etc. (6.2.6) |
| Hemodynamic | Studies of devices, approach, and tests of hemodynamics (6.6.5); studies of routine CT, lung ultrasound, electrical impedance tomography (6.5.2) |
| Other lung | |
| Other drugs | Studies of many agents (4.7; 11.9) |
| ECMO | |
| ECMO type | Studies of extracorporeal co2 removal (8.4) |
| Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility | |
| Assessment | Medications for prevention and/or treatment of delirium (5.2.3) |
| General approach | |
| Fluids | Validated measure of nonpulmonary organ system dysfunction (2.4.3) |
| Nutrition | Reporting of nutrition strategy in research studies (5.4.5) |
| Blood | Studies of packed RBC and alternatives (5.6.3) |
| Post-PICU follow-up | |
| Initial | Assessment of pre-PICU baseline state if follow-up is anticipated (9.4.1); practices to optimize follow-up (9.4.5) |
| Assessment | Postdischarge endpoints (9.4.2); relationship between short- and longer-term outcomes (9.4.3); factors affecting trajectory of recovery (9.4.4) |
ECMO = extracorporeal membrane oxygenation, MV = mechanical ventilation, RLS = resource-limited settings, Vt = tidal volume.
a
The premise of research needed statements (which is not referenced in the Table) is that everything in the Research column needs a dimension that is relevant to RLS, as well as collaboration between the spectrum of resourced settings.
The corresponding definition statement numbers are indicated in parentheses.