Pediatric Acute Respiratory Distress Syndrome (ARDS) Management Trial

Inclusion Criteria

• •Inclusion:
• •1. age \> 2 weeks (\> 38 weeks corrected gestational age) and \< 18 years (not yet had 18th birthday)
• •2. acute (≤ 7 days of risk factor) respiratory failure requiring invasive mechanical ventilation
• •3. ventilated with endotracheal tube or tracheostomy for ≤ 7 days from risk factor onset
• •4. hypoxemia defined as PaO2/FIO2 (measurement of the amount of oxygen dissolved in the blood plasma/concentration of inhaled oxygen) \> 300 (or SpO2/FIO2 (measurement of the percentage of hemoglobin in your blood that is carrying oxygen/concentration of inhaled oxygen) \> 315 on Positive End-Expiratory Pressure (PEEP) ≥ 5 cmH2O (rate of pressure delivery) on two consecutive measurements 4 hours apart and sustained at the time of consent and randomization
• •5. bilateral opacities on chest radiograph as determined by radiologist, clinical attending, or PI
• •Exclusion:
• •1. hypoxemia caused primarily by hydrostatic pulmonary edema from heart failure or fluid overload
• •2. non-palliated or unrepaired cyanotic congenital heart disease
• •3. ventilated via tracheostomy at baseline prior to acute illness
• •4. obstructive airway disease determined to be the primary cause of respiratory failure
• •5. severe moribund state not expected to survive \> 72 hours
• •6. any limitations of care at time of screening
• •7. escalation to high frequency oscillatory ventilation or extracorporeal support (i.e., meeting PARMA protocol failure criteria) at time of screening
• •8. previous enrollment in this study