Generic placeholder image

Current Pediatric Reviews

Editor-in-Chief

ISSN (Print): 1573-3963
ISSN (Online): 1875-6336

Review Article

Respiratory Therapeutic Strategies in Children and Adolescents with COVID-19: A Critical Review

Author(s): Giovana Pascoali Rodovanski, Susana da Costa Aguiar, Bruna Samantha Marchi, Patricia do Nascimento Oliveira, Livia Arcêncio, Danielle Soares Rocha Vieira and Cristiane Aparecida Moran*

Volume 17, Issue 1, 2021

Published on: 23 November, 2020

Page: [2 - 14] Pages: 13

DOI: 10.2174/1573396316999201123200936

Price: $65

Abstract

Evidence on the treatment strategies for the child population with critical conditions due to COVID-19 is scarce and lacks consensus. Thus, this study aimed to critically review non-pharmacological respiratory strategies for this population. Original studies were searched in six databases considering predefined inclusion criteria. Other studies and recommendations were also included after a manual search. Oxygen therapy, invasive (IMV) and non-invasive (NIV) ventilation were the most frequently addressed interventions. In general, the original studies have cited these strategies, but detailed information on the parameters used was not provided. The recommendations provided more detailed data, mainly based on experiences with other acute respiratory syndromes in childhood. In the context of oxygen therapy, the nasal catheter was the most recommended strategy for hypoxemia, followed by the high-flow nasal cannula (HFNC). However, the risks of contamination due to the dispersion of aerosols in the case of the HFNC were pointed out. Lung protective IMV with the use of bacteriological or viral filters was recommended in most documents, and there was great variation in PEEP titration. Alveolar recruitment maneuvers were mentioned in a few recommendations. NIV was not consensual among studies, and when selected, several precautions must be taken to avoid contamination. Airway suctioning with a closed-circuit was recommended to reduce aerosol spread. Information on prone positioning and physiotherapy was even more scarce. In conclusion, oxygen therapy seems to be essential in the treatment of hypoxemia. If necessary, IMV should not be delayed, and protective strategies are encouraged for adequate pulmonary ventilation. Information about techniques that are adjuvant to ventilatory support is superficial and requires further investigation.

Keywords: COVID-19, physiotherapy, infants, children, mechanical ventilation, oxygen inhalation therapy.

Graphical Abstract
[1]
Sankar J, Dhochak N, Kabra SK, Lodha R. COVID-19 in Children: Clinical Approach and Management. Indian J Pediatr 2020; 87(6): 433-42.
[http://dx.doi.org/10.1007/s12098-020-03292-1] [PMID: 32338347]
[2]
Coronavirus disease (COVID-19) pandemic 2020. Available from: www.who.int/emergencies/diseases/novel-coronavirus-2019
[3]
Cai J, Xu J, Lin D, et al. A case series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clin Infect Dis 2019; 71(6): 1547-51.
[4]
Morand A, Fabre A, Minodier P, Boutin A, Vanel N, Bosdure E, et al. COVID-10 Virus in children: what do we know? Arch Pediatr 2020; 27(3): 117-8.
[http://dx.doi.org/10.1016/j.arcped.2020.03.001]
[5]
Dong Y, Mo X, Hu Y, et al. Epidemiological Characteristics of 2143 Pediatric Patients with 2019 Coronavirus Disease in China. Pediatrics 2020; 145(6): e20200702.
[http://dx.doi.org/10.1542/peds.2020-0702]
[6]
Shen KL, Yang YH, Jiang RM, et al. China National Clinical Research Center for Respiratory Diseases; National Center for Children’s Health, Beijing, China; Group of Respirology, Chinese Pediatric Society, Chinese Medical Association; Chinese Medical Doctor Association Committee on Respirology Pediatrics; China Medicine Education Association Committee on Pediatrics; Chinese Research Hospital Association Committee on Pediatrics; China Non-government Medical Institutions Association Committee on Pediatrics; China Association of Traditional Chinese Medicine, Committee on Children’s Health and Medicine Research; China News of Drug Information Association, Committee on Children’s Safety Medication; Global Pediatric Pulmonology Alliance. Updated diagnosis, treatment and prevention of COVID-19 in children: experts’ consensus statement (condensed version of the second edition). World J Pediatr 2020; 16(3): 232-9.
[http://dx.doi.org/10.1007/s12519-020-00362-4] [PMID: 32333248]
[7]
Shen KL, Yang YH, Jiang RM, et al. Update diagnosis, treatment and prevention of covid-19 in children: experts’ consensus statement (Condensed Version of the Second Edition). World J Pediatr 2020; 16(3): 232-9.
[8]
Brodin P. Why is COVID-19 so mild in children? Acta Paediatr 2020; 109(6): 1082-3.
[http://dx.doi.org/10.1111/apa.15271] [PMID: 32212348]
[9]
Mahase E. Covid-19: concerns grow over inflammatory syndrome emerging in children. BMJ 2020; 369: m1710.
[http://dx.doi.org/10.1136/bmj.m1710] [PMID: 32345602]
[10]
WHO - World Health Organization. Clinical Management of COVID-19. WHO 2020. Available from: www.who.int/publica- tions/i/item/clinical-management-of-covid-19
[11]
Chen Z-M, Fu JF, Shu Q, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus. World J Pediatr 2020; 16(3): 240-6.
[http://dx.doi.org/10.1007/s12519-020-00345-5] [PMID: 32026148]
[12]
ASSOBRAFIR. Manejo Fisioterapêutico da População Neonatal. 2020. Available from: https://assobrafir.com.br/covid-19-manejo-fisioterapeutico-da-populacao-neonatal/
[13]
Liu W, Zhang Q, Chen J, et al. Detection of covid-19 in children in early january 2020 in Wuhan, China. N Engl J Med 2020; 382(14): 1370-1.
[http://dx.doi.org/10.1056/NEJMc2003717] [PMID: 32163697]
[14]
Lu X, Zhang L, Du H, et al. Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 infection in children. N Engl J Med 2020; 382(17): 1663-5.
[http://dx.doi.org/10.1056/NEJMc2005073] [PMID: 32187458]
[15]
Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features 36 children with Coronavirus Disease 2019 9 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet 2020; 20(6): 689-96.
[http://dx.doi.org/10.1016/S1473-3099(20)30198-5]
[16]
Sun D, Li H, Lu X-X, et al. Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a singles center’s observational study. World J Pediatr 2020; 16(3): 251-9.
[http://dx.doi.org/10.1007/s12519-020-00354-4]
[17]
Wei M, Yuan J, Liu Y, Fu T, Yu X, Zhang Z-J. Novel coronavirus infection in hospitalized infants under 1 year of age in China. JAMA 2020; 323(13): 1313-4.
[http://dx.doi.org/10.1001/jama.2020.2131] [PMID: 32058570]
[18]
Zhan Z-J, Yu X-J, Fu T, et al. Novel coronavirus infection in newborn babies under 28 days in China. Eur Respir J 2020; 55(6): 2000697.
[19]
Zheng F, Liao C, Fan Q-H, et al. Clinical characteristics of children with coronavirus disease 2019 in Hubei. 2020; 40(2): 275-80.
[http://dx.doi.org/10.1007/s11596-020-2172-6]
[20]
ASSOBRAFIR. Ventilação Mecânica em Pediatria. Comunicação Oficial ASSOBRAFIR COVID-19 ASSOBRAFIR 2020. Available from: https://assobrafir.com.br/covid-19-ventilacao-mecanica-em-pediatria/
[21]
ASSOBRAFIR. Manejo Fisioterapêutico na População Infantil. Comunicação Oficial ASSOBRAFIR COVID-19 ASSOBRAFIR 2020. Available from: https://assobrafir.com.br/covid-19_pediatria/
[22]
INDIA. Revised Guidelines on Clinical Management of COVID-19. Ministry of Health and Family Welfare 2020. Available from: https://www.mohfw.gov.in/pdf/RevisedNationalClinicalManagementGuidelineforCOVID1931032020.pdf
[23]
Sundaram M, Ravikumar N, Bansal A, et al. Intensive care chapter of indian academy of pediatrics. Novel coronavirus 2019 (2019-ncov) infection: part ii - respiratory support in the pediatric intensive care unit in resource-limited settings. Indian Pediatr 2020; 57(4): 335-42.
[http://dx.doi.org/10.1007/s13312-020-1786-x] [PMID: 32238613]
[24]
Calvo C, García López-Hortelano M, de Carlos Vicente JC, Vázquez Martínez JL. Grupo de trabajo de la Asociación Española de Pediatría para el brote de infección por Coronavirus, colaboradores con el Ministerio de Sanidad; Miembros del Grupo de Expertos de la AEP. Recommendations on the clinical management of the COVID-19 infection by the «new coronavirus» SARS-CoV2. Spanish Paediatric Association working group. An Pediatr (Barc) 2020; 92(4): 241.e1-241.e11.
[http://dx.doi.org/10.1016/j.anpedi.2020.02.001] [PMID: 32173188]
[25]
Tagarro A, Epalza C, Santos M, et al. Screening and severity of coronavirus disease 2019 (covid-19) in children in Madrid, Spain. JAMA Pediatrics 2020; e201346.
[26]
Sociedad Argentina de Pediatría. Recomendaciones de atención del paciente pediátrico con infección por SARS-CoV-2. 2020. Available from:https://www.sap.org.ar/uploads/archivos/general/files_segundo-encuentro-virtual-covid_1585328932.pdf
[27]
Shalish W, Lakshminrusimha S, Manzoni P, Keszler M, Sant’Anna GM. Covid-19 and neonatal respiratory care: Current evidence and practical approach. Am J Perinatol 2020; 37(8): 780-91.
[http://dx.doi.org/10.1055/s-0040-1710522] [PMID: 32359226]
[28]
Trujillo CHS. Colombian consensus for the care, diagnosis, and management of SARS-COV-2 / COVID-19 infection in health care facilities - recommendations based on expert consensus and informed by evidence. 2020; 24(3): Suppl I.
[29]
Chao JY, Derespina KR, Herold BC, et al. Clinical characteristics and outcomes of hospitalized and critically ill children and adolescents with coronavirus disease 2019 at a tertiary care medical center in New York City. J Pediatr 2020; 223: 14-19.e2.
[http://dx.doi.org/10.1016/j.jpeds.2020.05.006] [PMID: 32407719]
[30]
Rahimzadeh G, Noghabi ME, Elyaderani FK, et al. Covid-19 infection in Irian children: a case series of 9 patients. J Pediatr Review 2020; 2020(2): 139-344.
[31]
Brambilla I, Tosca MA, Filippo MD, et al. Special issues for COVID-19 in children and adolescents. Obesity (Silver Spring) 2020; 28(8): 1369.
[32]
Mexican Association of Pediatrics. Synthesis of COVID-19 infection in the newborn based on the information arising from the pandemic. 2020. Available from: https://amp.org.mx/wp-content/uploads/Covid19RecienNacido.pdf
[33]
ANZPID - Australia and New Zealand Paediatric Infectious Disease Group. Interim guidelines for the clinical management of COVID-19 in children and adolescents. 2020. Available from: https://www.asid.net.au/documents/item/1909
[34]
PARAGUAY. Ministerio de Salud Pública y Bienestar Social. CORONAVIRUS COVID-19 Manejo Clínico en Pediatría 2020. Available from: https://www.mspbs.gov.py/dependencias/portal/adjunto/850c83-COVID19ManejoenPediatra25.03.2020.pdf
[35]
Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during Pregnancy and Possible Vertical Transmission. Am J Perinatol 2020; 37(8): 861-5.
[http://dx.doi.org/10.1055/s-0040-1710050] [PMID: 32305046]
[36]
KENYA- Ministry of Health. Guidelines on the Management of Paediatric Patients During COVID-19 Pandemic. 2020. Available from: https://www.health.go.ke/wp-content/uploads/2020/06/PAEDIATRIC-Covid-Guidelines-Final.pdf
[37]
RCPCH - Royal College of Paediatrics and Child Health. COVID-19 - Guidance for Neonatal Settings. 2020. Available from: https://www.rcpch.ac.uk/resources/covid-19-guidance-neonatal-settings
[38]
Kneyber MCJ, Medina A, Alapont VMI, et al. Practice recommendations for the management of children with suspected or proven COVID-19 infections from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC) and the section Respiratory Failure from the European Society for Paediatric and Neonatal Intensive Care (ESPNIC). Paediatric Mechanical Ventilation Consensus Conference Section Respiratory Failure - European Society for Paediatric and Neonatal Intensive Care 2020. Available from: https://espnic-online.org/News/Latest-News/Practice-recommendations-for-managing-children-with-proven-or-suspected-COVID-19
[39]
CDC COVID-19 Response Team. Coronavirus disease 2019 in children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep 2020; 69(14): 422-6.
[http://dx.doi.org/10.15585/mmwr.mm6914e4] [PMID: 32271728]
[40]
Balasubramanian S, Rao NM, Goenka A, Roderick M, Ramanan AV. Coronavirus disease 2019 (Covid-19) in children - what we know so far and what we do not. Indian Pediatr 2020; 57(5): 435-42.
[http://dx.doi.org/10.1007/s13312-020-1819-5] [PMID: 32273490]
[41]
ClinicalTrials.gov; Bethesda (MD): National Library of Medicine (US). Lung Recruitment Device for COVID-19. 2000. Available from: https://clinicaltrials.gov/ct2/show/NCT04361435
[42]
ClinicalTrials.gov; Bethesda (MD): National Library of Medicine (US). The Effects of Pulmonary Physiotherapy Treatments on Patients With COVID-19. 2000. Available from: https://clinicaltrials.gov/ct2/show/NCT04357340
[43]
Ferioli M, Cisternino C, Leo V, Pisani L, Palange P, Nava S. Protecting Healthcare Workers From SARS-CoV-2 Infection: Practical Indications. Eur Respir Rev Society 2020; 29(155): 200068.
[44]
Lodeserto FJ, Lettich TM, Rezaie SR. High-flow Nasal Cannula: Mechanisms of Action and Adult and Pediatric Indications. Cureus 2018; 10(11): e3639.
[http://dx.doi.org/10.7759/cureus.3639] [PMID: 30740281]
[45]
PALICC- Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the pediatric acute lung injury consensus conference. Pediatr Crit Care Med 2015; 16(5): 428-39.
[46]
Kneyber MCJ, de Luca D, Calderini E, et al. Section respiratory failure of the european society for paediatric and neonatal intensive care. recommendations for mechanical ventilation of critically ill children from the paediatric mechanical ventilation consensus conference (pemvecc). Intensive Care Med 2017; 43(12): 1764-80.
[http://dx.doi.org/10.1007/s00134-017-4920-z] [PMID: 28936698]
[47]
Khemani RG, Parvathaneni K, Yehya N, Bhalla AK, Thomas NJ, Newth CJL. Positive end-expiratory pressure lower than the ards network protocol is associated with higher pediatric acute respiratory distress syndrome mortality. Am J Respir Crit Care Med 2018; 198(1): 77-89.
[http://dx.doi.org/10.1164/rccm.201707-1404OC] [PMID: 29373802]
[48]
Sociedade Brasileira de Pediatria. Uso de filtros Bacterianos/Virais nos equipamentos para suporte respiratório no Período Neonatal -Orientações Práticas. 2020. Available from: https://www.sbp.com.br/imprensa/detalhe/nid/uso-de-filtros-bacterianosvirais-nos-equipamentos-para-suporte-respiratorio-no-periodo-neonatal-orientacoes-praticas/
[49]
Johnston C, Zanetti NM, Comaru T, Ribeiro SNS, Andrade LB, Santos SLL. I Brazilian recommendation of respiratory physiotherapy in a pediatric and neonatal intensive care unit. Rev Bras Ter Intensiva 2012; 24(2): 119-29.
[http://dx.doi.org/10.1590/S0103-507X2012000200005]
[50]
Tamburro RF, Kneyber MCJ. Pediatric acute lung injury consensus conference group. pulmonary specific ancillary treatment for Pediatr Crit Care Med. 16(5 Suppl 1): S61-72.
[http://dx.doi.org/10.1097/PCC.0000000000000434]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy