When to Use Neuromuscular Blockade Versus Spontaneous Breathing

In this World Shared Practice Forum podcast, Dr. Robinder Khemani, co-author of the PALICC-2 guidelines, discusses the real-world application of pediatric ARDS management strategies. Through a case-based conversation, Dr. Khemani shares nuanced insights on intubation timing, ventilator settings, neuromuscular blockade, and rescue therapies, including ECMO. He also introduces the REDvent trial, a novel approach to lung and diaphragm protective ventilation. This content is ideal for clinicians, respiratory therapists, and healthcare educators seeking to deepen their understanding of evidence-informed, physiology-driven care in pediatric acute respiratory distress syndrome. LEARNING OBJECTIVES - Analyze the clinical decision-making process for intubation in pediatric ARDS - Apply PEEP titration techniques to assess lung recruitability in patients with PARDS - Evaluate the role of neuromuscular blockade in maintaining lung protective ventilation - Identify appropriate advanced rescue therapies based on PARDS phenotypes - Explore the principles and outcomes of the REDvent trial in ventilator management AUTHORS Robinder "Roby" Khemani, MD, MsCI Professor of Pediatrics, Vice Chair of Research University of Southern California, Department of Anesthesiology and Critical Care Medicine Children's Hospital Los Angeles Jeffrey Burns, MD, MPH Emeritus Chief Division of Critical Care Medicine Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital Professor of Anesthesia Harvard Medical School DATE Initial publication date: October 28, 2025. ARTICLE REFERENCED Khemani RG, Bhalla A, Hotz JC, et al. Randomized Trial of Lung and Diaphragm Protective Ventilation in Children. NEJM Evid. 2025;4(6):EVIDoa2400360. doi:10.1056/EVIDoa2400360 TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/at/47wbxnvxtcpvv54p48gc2v/202510_WSP_Khemani_Transcript.pdf Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Khemani RG, Burns JP. Practical Strategies for Management of Patients with Pediatric ARDS. 10/2025. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/practical-strategies-for-management-of-patients-with-pediatric-ards-by-r-khemani-openpediatrics.