{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T12:24:02Z","timestamp":1793363042872,"version":"4.5.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2020,6,1]],"date-time":"2020-06-01T00:00:00Z","timestamp":1590969600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Few data exist to guide early adjunctive therapy use in pediatric acute respiratory distress syndrome (PARDS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe contemporary use of adjunctive therapies for early PARDS as a framework for future investigations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a preplanned substudy of a prospective, international, cross-sectional observational study of children with PARDS from 100 centers over 10 study weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>We investigated six adjunctive therapies for PARDS: continuous neuromuscular blockade, corticosteroids, inhaled nitric oxide (iNO), prone positioning, high-frequency oscillatory ventilation (HFOV), and extracorporeal membrane oxygenation. Almost half (45%) of children with PARDS received at least one therapy. Variability was noted in the median starting oxygenation index of each therapy; corticosteroids started at the lowest oxygenation index (13.0; interquartile range, 7.6\u201322.0) and HFOV at the highest (25.7; interquartile range, 16.7\u201337.3). Continuous neuromuscular blockade was the most common, used in 31%, followed by iNO (13%), corticosteroids (10%), prone positioning (10%), HFOV (9%), and extracorporeal membrane oxygenation (3%). Steroids, iNO, and HFOV were associated with comorbidities. Prone positioning and HFOV were more common in middle-income countries and less frequently used in North America. The use of multiple ancillary therapies increased over the first 3 days of PARDS, but there was not an easily identifiable pattern of combination or order of use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The contemporary description of prevalence, combinations of therapies, and oxygenation threshold for which the therapies are applied is important for design of future studies. Region of the world, income, and comorbidities influence adjunctive therapy use and are important variables to include in PARDS investigations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201909-1807oc","type":"journal-article","created":{"date-parts":[[2020,3,4]],"date-time":"2020-03-04T17:07:25Z","timestamp":1583341645000},"page":"1389-1397","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":47,"title":["Early Use of Adjunctive Therapies for Pediatric Acute Respiratory Distress Syndrome: A PARDIE Study"],"prefix":"10.1093","volume":"201","author":[{"given":"Courtney M.","family":"Rowan","sequence":"first","affiliation":[{"name":"Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at IU Health, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret J.","family":"Klein","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Children\u2019s Hospital of Los Angeles and University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deyin Doreen","family":"Hsing","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, New York Presbyterian Hospital and Weill Cornell Medical College, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary K.","family":"Dahmer","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children\u2019s Hospital and University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip C.","family":"Spinella","sequence":"additional","affiliation":[{"name":"Division of Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillaume","family":"Emeriaud","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine and Universit\u00e9 de Montr\u00e9al, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda B.","family":"Hassinger","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, Oishei Children\u2019s Hospital and University of Buffalo, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byron E.","family":"Pi\u00f1eres-Olave","sequence":"additional","affiliation":[{"name":"Hospital Pablo Tob\u00f3n Uribe, Medell\u00edn, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi R.","family":"Flori","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children\u2019s Hospital and University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bereketeab","family":"Haileselassie","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, Stanford University, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yolanda M.","family":"Lopez-Fernandez","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cruces University Hospital, Bizkaia, Basque Country, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranjit S.","family":"Chima","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children\u2019s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven L.","family":"Shein","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, Rainbow Babies and Children\u2019s Hospital and Case Western Reserve University, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline B.","family":"Maddux","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital Colorado and University of Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Lillie","sequence":"additional","affiliation":[{"name":"Evelina London Children\u2019s Hospital, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ledys","family":"Izquierdo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital Militar Central, Bogot\u00e1, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin C. 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