Dr. Robinder Khemani, a leading expert in pediatric ARDS and co-author of the PALICC-2 guidelines, shares his insights on ventilator management in children. He discusses critical decisions around intubation timing and the importance of PEEP titration for lung recruitability in patients. Khemani explores rescue therapies based on patient phenotypes and presents the REDvent trial, highlighting its innovative approach to lung protection. He even touches on the implications of permissive hypercapnia in treatment strategies. A must-listen for healthcare professionals!
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volunteer_activism ADVICE
Time-Limited Trial Of Noninvasive Support
Trial noninvasive support quickly and set a strict time limit to assess response.
If no clear improvement within 30–60 minutes, intubate to avoid unsafe delayed intervention.
insights INSIGHT
Phenotype-Directed Respiratory Support
PARDS phenotypes differ by recruitability and drive, which dictates support choice.
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.
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