Management of Hypoxia in Pediatric Population Affected with COVID-19

ABSTRACT

Pediatric acute respiratory distress syndrome (PARDS) is a life-threatening condition characterized by hypoxemia and is the most important cause of respiratory failure .It has been proposed that adult COVID-19 respiratory illness has two phenotypes a low compliance ARDS- like phenotype and a normal compliance phenotype with low ventilation to perfusion ratio. The normal compliance phenotype is theorized to be due to a loss of hypoxic pulmonary vasoconstriction although the pediatric presentation in critical care has not been reported yet;the adult phenotype could be considered when managing pediatric patients with severe COVID-19. PARDS characterized by hypoxemia, radiographic haziness and decreased lung ,compliance per the criteria purposed by the pediatric acute lung injury consensus conference group (PALICC). High frequency nasal cannula or NIV by CPAP or BIPAP has been used successfully in pediatric patient with COVID-19 hypoxemia but increases risk of aerosolization and air born transmission that obligate strict airborne precautions. Management in ICU aims to maintain oxygenation while minimizing ventilation induced lung injury (VILI). For mechanical ventilation oxygen supplementation to maintain SPO2 > 92% and OI < 4 or OSI < 5 is recommended. Prone position and HFO ventilation (HFOV) are mostly utilized as rescue oxygenation. Prone position has been used as an adjunct therapy in adult patients with COVID 19 as chest computed tomography shows ground-glass appearance and depended lung injury. Pediatric evidence supp onorting prone position is scarce;however, there have been promising results with improved ventilation in dependent lung regions If HFOV is considered in patients with COVID-19, it should be used cautiously due to the high risk of aerosolization.