Ultrasound-guided lung recruitment maneuver in pediatric acute respiratory distress syndrome.

1. To investigate the application of bedside ultrasound in guiding lung recruitment maneuvers (RM) in pediatric acute respiratory distress syndrome (PARDS). 2. To compare the efficacy of bedside ultrasound-guided lung RM (US) with that of maximal oxygen-guided lung RM (OXY) in the management of PARDS. Prospective interventional trial, Single arm test.This study involved a cohort of 24 pediatric patients in the Pediatric Intensive Care Unit (PICU) at Shiyan Taihe Hospital from January 2018 to December 2024, The participants, with an average age of 36.79 ± 38.72 months, comprised 14 males and 10 females, all of whom met the diagnostic criteria for pediatric acute respiratory distress syndrome and underwent invasive mechanical ventilation. Lung recruitment therapy was implemented following the protocol established by Wolf GK, which is structured into two distinct phases: the baseline segment, and the recruitment segment. Lung ultrasonography and arterial blood gas analyses were conducted at three intervals—prior to, during, and following the recruitment process for each child. An ultrasound reaeration score (URS) was calculated, and each child was required to satisfy two consecutive recruitment criteria. Key parameters, including opening pressure, ultrasound reaeration score, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide(PaCO2),and dynamic compliance (Cdyn) were recorded for both lung ultrasound-guided recruitment and maximal oxygenation-guided recruitment.The data collected before and after the recruitment process were subjected to statistical analysis. Twenty-three children achieved the designated recruitment endpoint. In comparison to the OXY group, the ultrasound group (URS) exhibited a significantly higher recruitment score (t= – 8.833, p < 0.05) and elevated opening pressure (Popen) (t=།8.891, p ≤ 0.05). Lung compliance showed a marked improvement (CdynUS-CdynOXY: 0.405 ± 0.030 ml/cmH2O/kg, p < 0.05), and arterial oxygenation levels increased significantly (PaO2 US-PaO2 OXY: 14.174 ± 1.979mmHg, p < 0.05). Additionally, the CO2 retention at the recruitment endpoint improved under both conditions, with a more pronounced improvement observed in the ultrasound group (PaCO2 US-PaCO2 OXY: -5.391 ± 1.003 mmHg, p < 0.05). However, one child with leukemia complicated by fungal pneumonia and pediatric acute respiratory distress syndrome (PARDS) experienced intracranial hemorrhage due to thrombocytopenia, necessitating the premature termination of treatment. The utilization of bedside lung ultrasound-guided lung recruitment maneuvers in pediatric acute respiratory distress syndrome (PARDS) has been demonstrated to be effective. In comparison to the maximal oxygenation method, the lung recruitment achieved through the ultrasound-guided approach is more comprehensive.Clinical Trial Registration Number: ChiCTR2600119378. Reg Date: 26-02-2026.