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Although well described in the adult literature, descriptions of pulmonary thromboses with pediatric ARDS are limited to case reports. However, many risk factors for pulmonary thromboses are present in children with ARDS (eg, coagulopathy, endothelial injury, central venous catheters, concomitant inflammatory diseases), suggesting a much higher incidence is plausible. Based on an interpretation of animal, pediatric, and adult data, we propose a diagnostic algorithm to facilitate a timely and accurate diagnosis. Observing an alveolar dead space fraction \u2265 0.25, or either a 50% increase in physiologic dead space\/tidal volume or a central venous saturation \u2264 60% over 24 h, triggers the algorithm. Together with targeted heparin treatment and right ventricular afterload reduction, clinical outcomes might improve if this particular patient subgroup can be identified early. While anticoagulation is recommended in adults with confirmed pulmonary embolism and low early mortality risk, data for children are limited.<\/jats:p>","DOI":"10.4187\/respcare.06106","type":"journal-article","created":{"date-parts":[[2018,12,24]],"date-time":"2018-12-24T17:55:11Z","timestamp":1545674111000},"page":"209-216","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Pulmonary Thromboses in Pediatric Acute Respiratory Distress Syndrome"],"prefix":"10.1177","volume":"64","author":[{"given":"Magalie","family":"Caudron","sequence":"first","affiliation":[{"name":"Division of Pediatric Critical Care, University of British Columbia, Vancouver, British Columbia, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanya","family":"Holt","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoff DE","family":"Cuvelier","sequence":"additional","affiliation":[{"name":"Pediatric Hematology-Oncology-BMT, CancerCare Manitoba, Winnipeg, Manitoba, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Dmytrowich","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Hansen","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,12,24]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(67)90168-7"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000432"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000433"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000436"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000435"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000438"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-014-0028-6"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201002-0250OC"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-013-2941-9"},{"issue":"5","key":"e_1_3_2_11_2","first-page":"593","article-title":"Early bedside detection of pulmonary vascular occlusion during acute respiratory failure","volume":"124","author":"Greene R","year":"1981","unstructured":"Greene R, , Zapol WM, , Snider MT, , Reid L, , Snow R, , O'Connell RS, , Novelline RA. 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