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Update In intensive care medicine: Pediatric intensive care
Available online 2 February 2026

Acute respiratory distress syndrome in the pediatric patient

Síndrome de distrés respiratorio agudo en el paciente crítico pediátrico
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Susana Reyes-Domíngueza,
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susanabeatriz.reyes@um.es

Corresponding author.
, Ana Abril-Molinab, Raúl Montero-Yébolesc, Vicente Modesto i Alapontd
a Unidad de Medicina Intensiva Pediátrica, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
b Unidad de Medicina Intensiva Pediátrica, Hospital Universitario Virgen de las Nieves, Ibs, Granada, Spain
c Unidad de Medicina Intensiva Pediátrica, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
d Unidad de Medicina Intensiva Pediátrica, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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Abstract

Pediatric acute respiratory distress syndrome (PARDS) is the clinical expression of severe non-cardiogenic pulmonary edema.

The agreed-upon definition shares common criteria with those for adults, but also includes differences determined by the particular characteristics inherent to pediatric patients. The definition of PARDS does not require bilateral infiltrates on the chest X-ray; hypoxemia can be identified non-invasively using the blood oxygen saturation/fraction of inspired oxygen (S/F) ratio; it is stratified into two groups (mild-moderate and severe) after a stabilization period of at least 4 h; and the oxygenation index and the oxygenation-saturation ratio are used in intubated patients.

Optimized respiratory support settings should prevent lung injury and allow for early identification of patients requiring extracorporeal membrane oxygenation (ECMO). This article seeks to conduct a critical analysis of PARS. A precise diagnosis of this syndrome remains challenging.

Keywords:
Pediatric Acute Respiratory Distress Syndrome
Acute respiratory failure
Pediatric Acute Lung Injury Consensus Conference
Respiratory distress
Mechanical ventilation
Resumen

El síndrome de distrés respiratorio agudo pediátrico (SDRAP) constituye la expresión clínica de un edema pulmonar grave no cardiogénico.

La definición consensuada comparte criterios comunes con la del adulto, pero también diferencias determinadas por la idiosincrasia del niño. La definición del SDRAP no necesita bilateralidad en la radiografía de tórax, se permite identificar la hipoxemia por métodos no invasivos con el cociente saturación de oxígeno por pulsioximetría/fracción inspirada de oxígeno (S/F), se estratifica en dos grupos (leve-moderado y grave) tras un periodo de estabilización de al menos 4 horas, y se utiliza el índice de oxigenación (IO) y el índice oxigenación-saturación en pacientes intubados. La programación de un soporte respiratorio optimizado debería evitar la lesión pulmonar y permitir identificar precozmente a los pacientes que requieren oxigenación por membrana extracorpórea (ECMO).

Este artículo busca realizar un análisis crítico sobre el SDRAP. Diagnosticar de forma certera este síndrome es todavía un reto.

Palabras clave:
Síndrome de distrés respiratorio agudo pediátrico
Insuficiencia respiratoria aguda
Conferencia Consenso sobre lesión pulmonar aguda pediátrica
Distrés respiratorio
Ventilación mecánica

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