Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Acute Respiratory Distress Syndrome Clinical Presentation

  • Author: Prashant Purohit, MD; Chief Editor: Timothy E Corden, MD  more...
 
Updated: Jan 21, 2016
 

History

Histories at the time of initial presentation offer a little with regards to the diagnosis of ARDS because of diverse etiologies and the heterogeneity of susceptibility. However, the definition of “At risk of PARDS” might help clinician to closely monitor certain population. [2]

Next

Physical Examination

The onset of ARDS can be as rapid as few hours, but it can have a gradual onset with evolution of clinical features over 1 to 5 days. The evolution of clinical signs depends on the type, acuity, and severity of the initial insult. As lungs undergo changes during the first exudative stage of the disease, tachypnea is typically noted as the initial physical finding. Respiratory distress, agitation and hypoxemia could be other initial clinical features at this stage. Crackles may be audible throughout the lung fields, signifying pulmonary edema coinciding with infiltrates on chest radiographs. Concomitant fever may reflect the underlying process causing ARDS (eg, pneumonia, sepsis) or may reflect massive cytokine release. Although these are non-specific features and can be seen with any other respiratory or even systemic illness. Hypoxemia might be evident by high oxygen requirement, higher CPAP or PEEP and elevated alveolar-arterial (A-a) oxygen gradient. A-a gradient can be calculated from the equation as mentioned below for the sea level assuming 100% humidification at the alveolar level. Link the equation.

A-a gradient = PAO2 – PaO2 = {FiO<sub>2</sub> (Patm – PH<sub>2</sub>O) – PaCO<sub>2</sub>/0.8} – PaO2

                     = {0.6 (760-46) – 40/0.8} – 85

                     = {428.4 – 50} – 85

                     = 293.4 

This is for the patient that was discussed earlier for other calculations, who was on mechanical ventilation with FiO2 0.6, PaO2 of 85, SPO2 of 98% and PCO2 of 40 mm Hg.

Reduction in lung compliance and functional residual capacity is noticed with the development of pulmonary edema. Hypoxemia results from intrapulmonary shunting and ventilation-perfusion mismatch. At this stage, utilization of high PEEP will help in oxygenation by alveolar recruitment. Certain areas of lung still would have maintained normal lung compliance and remain at risk of air leak syndromes from high PEEP. After the initiation of fibro proliferation, lung compliance is further reduced. Benefit of PEEP on oxygenation is less remarkable at this stage. In fact, difficulty in achieving adequate ventilation might be experienced at this stage with resultant hypercarbia and respiratory acidosis. The requirement of mechanical ventilation might be as long as few weeks with overall clinical recovery in months. Pediatric patients have exhibited reduced lung function, broncho reactivity, muscle wasting and weakness for a prolonged period of time after survival from ARDS.[45]

Previous
Next

Complications

Several complications are associated with ARDS, though many of these are due to the precipitating conditions that lead to ARDS. Acute complications include air-leak syndromes, ventilator-induced lung infection (VILI), and multiple organ dysfunction syndrome (MODS), although definitive evidence linking this syndrome to ARDS or ventilator use remains controversial.

Numerous pulmonary complications may result from ARDS. The most common are the air-leak syndromes, particularly pneumothorax but also pneumomediastinum, pneumopericardium, pneumoperitoneum, and subcutaneous emphysema. Features of a pneumothorax include decreased air entry on the side of the air leak, an increased percussion note on the same side, and tracheal deviation away from the affected side in a tension pneumothorax. Heart sounds may be muffled, and signs of decreased cardiac output may be observed with a tension pneumothorax. Clinicians must also maintain a high index of suspicion for tension pneumothoraces as a cause for acute onset of decreased cardiac output.

VILI is an entity receiving attention with the publication of landmark trials suggesting that a “kinder, gentler” form of mechanical ventilation improves outcomes in ARDS. VILI most likely has several causes, including excessive lung stretching due to high tidal volumes, repetitive opening and closing of alveoli leading to shear stress, oxygen toxicity, and cytokine release.

ARDS patients may also be compromised from a cardiovascular standpoint. Patients with sepsis, trauma, or other multisystem insults may lose their ability to tolerate higher airway pressures often required to maintain adequate oxygenation. Higher airway pressures lead to a higher net intrathoracic pressure, which results in decreased preload and cardiac output. Moreover, hypoxia, hypercarbia, and acidosis may elevate pulmonary artery pressures, increasing right ventricular afterload and leading to increased right ventricular work. Right ventricular dilatation can develop and then result in leftward movement of the intraventricular septum and cause left ventricular outflow tract obstruction.

Gastrointestinal complications commonly observed in the critically ill population include stress ulcers, liver failure, pancreatitis, and pancreatic insufficiency, leading to glucose intolerance.

Renal failure may result from the primary illness or may occur secondarily as a result of poor cardiac output, acute tubular necrosis, and MODS.

Secondary or nosocomial pneumonia is not uncommon in critically ill children. In addition to Staphylococcus aureus, other organisms more typically isolated include Pseudomonas species, Acinetobacter baumanniiStenotrophomonas maltophiliaEscherichia coli, and Candida species. Bacteremia from indwelling vascular catheters and skin ulcerations may also occur. Risk of urinary tract infection increases with prolonged indwelling Foley catheters.

Critical illness polyneuropathy and myopathy (CIPNM) is seen in a subset of patients of unclear etiology. Many factors have been identified to have an increased association with CIPNM, such as sepsis, systemic inflammatory response syndrome, MODS, and prolonged mechanical ventilation. Use of muscle relaxants, especially in conjunction with steroids, appears to have a particularly high association with CIPNM. Initial reports describe CIPNM with concomitant use of nondepolarizing muscle relaxants and corticosteroids. However, case reports of weakness with cisatracurium and corticosteroids have also been described. Clinically, patients develop profound or flaccid weakness that is often prolonged. This may complicate the mechanical ventilator weaning process and may also require inpatient rehabilitation care upon discharge from the hospital.[46, 47]

Previous
 
 
Contributor Information and Disclosures
Author

Prashant Purohit, MD Pediatric Intensivist, Kapi’olani Medical Center for Women and Children

Disclosure: Nothing to disclose.

Coauthor(s)

Dale W Steele, MD, MS Associate Professor of Emergency Medicine and Pediatrics, Warren Alpert Medical School of Brown University; Attending Physician, Department of Pediatric Emergency Medicine, Rhode Island Hospital

Dale W Steele, MD, MS is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

G Patricia Cantwell, MD, FCCM Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami Leonard M Miller School of Medicine/ Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Director, Palliative Care Team, Holtz Children's Hospital; Medical Manager, FEMA, South Florida Urban Search and Rescue, Task Force 2

G Patricia Cantwell, MD, FCCM is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Lennox H Huang, MD, FAAP Associate Professor and Chair, Department of Pediatrics, McMaster University School of Medicine; Chief of Pediatrics, McMaster Children's Hospital

Lennox H Huang, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Physician Leadership, Canadian Medical Association, Ontario Medical Association, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Garry Wilkes, MBBS, FACEM Director of Clinical Training (Simulation), Fiona Stanley Hospital; Clinical Associate Professor, University of Western Australia; Adjunct Associate Professor, Edith Cowan University, Western Australia

Disclosure: Nothing to disclose.

Andrew K Feng, MD Attending Physician, Division of Pediatric Critical Care, Kapiolani Medical Center for Women and Children

Andrew K Feng, MD is a member of the following medical societies: Society of Critical Care Medicine

Disclosure: Nothing to disclose.

References
  1. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012 Jun 20. 307(23):2526-33. [Medline].

  2. 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 Jun. 16 (5):428-39. [Medline].

  3. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967 Aug 12. 2 (7511):319-23. [Medline].

  4. Petty TL, Ashbaugh DG. The adult respiratory distress syndrome. Clinical features, factors influencing prognosis and principles of management. Chest. 1971 Sep. 60 (3):233-9. [Medline].

  5. Bernard GR, Artigas A, Brigham KL, et al. Report of the American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. The Consensus Committee. Intensive Care Med. 1994. 20(3):225-32. [Medline].

  6. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994 Mar. 149 (3 Pt 1):818-24. [Medline].

  7. Andrew B Lumb MB BS FRCA. Functional anatomy of the respiratory tract. Nunn’s Applied Respiratory Physiology. Seventh Edition. Churchill Livingstone Elsevier Ltd.; 2010. 13-26.

  8. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med. 2000 May 4. 342 (18):1334-49. [Medline].

  9. Berthiaume Y, Voisin G, Dagenais A. The alveolar type I cells: the new knight of the alveolus?. J Physiol. 2006 May 1. 572 (Pt 3):609-10. [Medline].

  10. Dos Santos CC. Advances in mechanisms of repair and remodelling in acute lung injury. Intensive Care Med. 2008 Apr. 34 (4):619-30. [Medline].

  11. Sapru A, Flori H, Quasney MW, Dahmer MK, Pediatric Acute Lung Injury Consensus Conference Group. Pathobiology of acute respiratory distress syndrome. Pediatr Crit Care Med. 2015 Jun. 16 (5 Suppl 1):S6-22. [Medline].

  12. Chen J, Chen Z, Chintagari NR, Bhaskaran M, Jin N, Narasaraju T, et al. Alveolar type I cells protect rat lung epithelium from oxidative injury. J Physiol. 2006 May 1. 572 (Pt 3):625-38. [Medline].

  13. Erickson S, Schibler A, Numa A, Nuthall G, Yung M, Pascoe E, et al. Acute lung injury in pediatric intensive care in Australia and New Zealand: a prospective, multicenter, observational study. Pediatr Crit Care Med. 2007 Jul. 8 (4):317-23. [Medline].

  14. Pepe PE, Potkin RT, Reus DH, Hudson LD, Carrico CJ. Clinical predictors of the adult respiratory distress syndrome. Am J Surg. 1982 Jul. 144 (1):124-30. [Medline].

  15. Fein AM, Lippmann M, Holtzman H, Eliraz A, Goldberg SK. The risk factors, incidence, and prognosis of ARDS following septicemia. Chest. 1983 Jan. 83 (1):40-2. [Medline].

  16. Paret G, Ziv T, Augarten A, Barzilai A, Ben-Abraham R, Vardi A, et al. Acute respiratory distress syndrome in children: a 10 year experience. Isr Med Assoc J. 1999 Nov. 1 (3):149-53. [Medline].

  17. Cullen ML. Pulmonary and respiratory complications of pediatric trauma. Respir Care Clin N Am. 2001 Mar. 7 (1):59-77. [Medline].

  18. Gong MN, Thompson BT, Williams P, Pothier L, Boyce PD, Christiani DC. Clinical predictors of and mortality in acute respiratory distress syndrome: potential role of red cell transfusion. Crit Care Med. 2005 Jun. 33 (6):1191-8. [Medline].

  19. Khan H, Belsher J, Yilmaz M, Afessa B, Winters JL, Moore SB, et al. Fresh-frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients. Chest. 2007 May. 131 (5):1308-14. [Medline].

  20. Neto AS, Simonis FD, Barbas CS, Biehl M, Determann RM, Elmer J, et al. Lung-Protective Ventilation With Low Tidal Volumes and the Occurrence of Pulmonary Complications in Patients Without Acute Respiratory Distress Syndrome: A Systematic Review and Individual Patient Data Analysis. Crit Care Med. 2015 Oct. 43 (10):2155-63. [Medline].

  21. Haddad IY. Stem cell transplantation and lung dysfunction. Curr Opin Pediatr. 2013 Jun. 25 (3):350-6. [Medline].

  22. Cooke KR. Acute lung injury after allogeneic stem cell transplantation: from the clinic, to the bench and back again. Pediatr Transplant. 2005 Dec. 9 Suppl 7:25-36. [Medline].

  23. Panoskaltsis-Mortari A, Griese M, Madtes DK, Belperio JA, Haddad IY, Folz RJ, et al. An official American Thoracic Society research statement: noninfectious lung injury after hematopoietic stem cell transplantation: idiopathic pneumonia syndrome. Am J Respir Crit Care Med. 2011 May 1. 183(9):1262-79. [Medline].

  24. Li G, Malinchoc M, Cartin-Ceba R, Venkata CV, Kor DJ, Peters SG, et al. Eight-year trend of acute respiratory distress syndrome: a population-based study in Olmsted County, Minnesota. Am J Respir Crit Care Med. 2011 Jan 1. 183 (1):59-66. [Medline].

  25. Luhr OR, Antonsen K, Karlsson M, Aardal S, Thorsteinsson A, Frostell CG, et al. Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF Study Group. Am J Respir Crit Care Med. 1999 Jun. 159 (6):1849-61. [Medline].

  26. Bersten AD, Edibam C, Hunt T, Moran J, Australian and New Zealand Intensive Care Society Clinical Trials Group. Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian States. Am J Respir Crit Care Med. 2002 Feb 15. 165 (4):443-8. [Medline].

  27. Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, et al. Incidence and outcomes of acute lung injury. N Engl J Med. 2005 Oct 20. 353 (16):1685-93. [Medline].

  28. Zhu YF, Xu F, Lu XL, Wang Y, Chen JL, Chao JX, et al. Mortality and morbidity of acute hypoxemic respiratory failure and acute respiratory distress syndrome in infants and young children. Chin Med J (Engl). 2012 Jul. 125 (13):2265-71. [Medline].

  29. López-Fernández Y, Azagra AM, de la Oliva P, Modesto V, Sánchez JI, Parrilla J, et al. Pediatric Acute Lung Injury Epidemiology and Natural History study: Incidence and outcome of the acute respiratory distress syndrome in children. Crit Care Med. 2012 Dec. 40 (12):3238-45. [Medline].

  30. Kneyber MC, Brouwers AG, Caris JA, Chedamni S, Plötz FB. Acute respiratory distress syndrome: is it underrecognized in the pediatric intensive care unit?. Intensive Care Med. 2008 Apr. 34 (4):751-4. [Medline].

  31. Zimmerman JJ, Akhtar SR, Caldwell E, Rubenfeld GD. Incidence and outcomes of pediatric acute lung injury. Pediatrics. 2009 Jul. 124 (1):87-95. [Medline].

  32. Bindl L, Dresbach K, Lentze MJ. Incidence of acute respiratory distress syndrome in German children and adolescents: a population-based study. Crit Care Med. 2005 Jan. 33 (1):209-312. [Medline].

  33. Moss M, Bucher B, Moore FA, Moore EE, Parsons PE. The role of chronic alcohol abuse in the development of acute respiratory distress syndrome in adults. JAMA. 1996 Jan 3. 275 (1):50-4. [Medline].

  34. Moazed F, Calfee CS. Environmental risk factors for acute respiratory distress syndrome. Clin Chest Med. 2014 Dec. 35 (4):625-37. [Medline].

  35. Calfee CS, Matthay MA, Eisner MD, Benowitz N, Call M, Pittet JF, et al. Active and passive cigarette smoking and acute lung injury after severe blunt trauma. Am J Respir Crit Care Med. 2011 Jun 15. 183 (12):1660-5. [Medline].

  36. Meyer NJ, Christie JD. Genetic heterogeneity and risk of acute respiratory distress syndrome. Semin Respir Crit Care Med. 2013 Aug. 34 (4):459-74. [Medline].

  37. Matthay MA, Ware LB, Zimmerman GA. The acute respiratory distress syndrome. J Clin Invest. 2012 Aug. 122 (8):2731-40. [Medline].

  38. Gao L, Barnes KC. Recent advances in genetic predisposition to clinical acute lung injury. Am J Physiol Lung Cell Mol Physiol. 2009 May. 296 (5):L713-25. [Medline].

  39. Wei Y, Wang Z, Su L, Chen F, Tejera P, Bajwa EK, et al. Platelet count mediates the contribution of a genetic variant in LRRC16A to ARDS risk. Chest. 2015 Mar. 147 (3):607-17. [Medline].

  40. Reilly JP, Christie JD. Linking genetics to ARDS pathogenesis: the role of the platelet. Chest. 2015 Mar. 147 (3):585-6. [Medline].

  41. Sheu CC, Zhai R, Su L, Tejera P, Gong MN, Thompson BT, et al. Sex-specific association of epidermal growth factor gene polymorphisms with acute respiratory distress syndrome. Eur Respir J. 2009 Mar. 33 (3):543-50. [Medline].

  42. Brun-Buisson C, Minelli C, Bertolini G, Brazzi L, Pimentel J, Lewandowski K, et al. Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study. Intensive Care Med. 2004 Jan. 30 (1):51-61. [Medline].

  43. Erickson SE, Shlipak MG, Martin GS, Wheeler AP, Ancukiewicz M, Matthay MA, et al. Racial and ethnic disparities in mortality from acute lung injury. Crit Care Med. 2009 Jan. 37 (1):1-6. [Medline].

  44. Moss M, Mannino DM. Race and gender differences in acute respiratory distress syndrome deaths in the United States: an analysis of multiple-cause mortality data (1979- 1996). Crit Care Med. 2002 Aug. 30 (8):1679-85. [Medline].

  45. Stephane Dauger, Philippe Durand, Etinne Javouey and Jean-Christophe Mercier. Acute Respiratory Distress Syndrome in Children. Pediatric Critical Care. Fourth edition. Philadelphia, PA 19103-2899.: Elsevier Saunders. Copyright 2011 by Mosby, Inc; 2011. 706-716.

  46. Visser LH. Critical illness polyneuropathy and myopathy: clinical features, risk factors and prognosis. Eur J Neurol. 2006 Nov. 13 (11):1203-12. [Medline].

  47. Murray MJ, Brull SJ, Bolton CF. Brief review: Nondepolarizing neuromuscular blocking drugs and critical illness myopathy. Can J Anaesth. 2006 Nov. 53 (11):1148-56. [Medline].

  48. Gattinoni L, Bombino M, Pelosi P, Lissoni A, Pesenti A, Fumagalli R, et al. Lung structure and function in different stages of severe adult respiratory distress syndrome. JAMA. 1994 Jun 8. 271 (22):1772-9. [Medline].

  49. Goodman LR, Fumagalli R, Tagliabue P, Tagliabue M, Ferrario M, Gattinoni L, et al. Adult respiratory distress syndrome due to pulmonary and extrapulmonary causes: CT, clinical, and functional correlations. Radiology. 1999 Nov. 213 (2):545-52. [Medline].

  50. Gorini M, Ginanni R, Villella G, Tozzi D, Augustynen A, Corrado A. Non-invasive negative and positive pressure ventilation in the treatment of acute on chronic respiratory failure. Intensive Care Med. 2004 May. 30 (5):875-81. [Medline].

  51. Zhao X, Huang W, Li J, Liu Y, Wan M, Xue G, et al. Noninvasive Positive-Pressure Ventilation in Acute Respiratory Distress Syndrome in Patients With Acute Pancreatitis: A Retrospective Cohort Study. Pancreas. 2016 Jan. 45 (1):58-63. [Medline].

  52. Antonelli M, Conti G, Esquinas A, Montini L, Maggiore SM, Bello G, et al. A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome. Crit Care Med. 2007 Jan. 35 (1):18-25. [Medline].

  53. Uçgun I, Yildirim H, Metintaş M, Güntülü AK. The efficacy of non-invasive positive pressure ventilation in ARDS: a controlled cohort study. Tuberk Toraks. 2010. 58 (1):16-24. [Medline].

  54. Teague WG. Noninvasive ventilation in the pediatric intensive care unit for children with acute respiratory failure. Pediatr Pulmonol. 2003 Jun. 35 (6):418-26. [Medline].

  55. Essouri S, Chevret L, Durand P, Haas V, Fauroux B, Devictor D. Noninvasive positive pressure ventilation: five years of experience in a pediatric intensive care unit. Pediatr Crit Care Med. 2006 Jul. 7 (4):329-34. [Medline].

  56. Bernet V, Hug MI, Frey B. Predictive factors for the success of noninvasive mask ventilation in infants and children with acute respiratory failure. Pediatr Crit Care Med. 2005 Nov. 6 (6):660-4. [Medline].

  57. Yañez LJ, Yunge M, Emilfork M, Lapadula M, Alcántara A, Fernández C, et al. A prospective, randomized, controlled trial of noninvasive ventilation in pediatric acute respiratory failure. Pediatr Crit Care Med. 2008 Sep. 9 (5):484-9. [Medline].

  58. Pancera CF, Hayashi M, Fregnani JH, Negri EM, Deheinzelin D, de Camargo B. Noninvasive ventilation in immunocompromised pediatric patients: eight years of experience in a pediatric oncology intensive care unit. J Pediatr Hematol Oncol. 2008 Jul. 30 (7):533-8. [Medline].

  59. Perry SA, Kesser KC, Geller DE, Selhorst DM, Rendle JK, Hertzog JH. Influences of cannula size and flow rate on aerosol drug delivery through the Vapotherm humidified high-flow nasal cannula system. Pediatr Crit Care Med. 2013 Jun. 14 (5):e250-6. [Medline].

  60. Mercat A, Richard JC, Vielle B, Jaber S, Osman D, Diehl JL, et al. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2008 Feb 13. 299 (6):646-55. [Medline].

  61. Ranieri VM, Suter PM, Tortorella C, De Tullio R, Dayer JM, Brienza A, et al. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA. 1999 Jul 7. 282 (1):54-61. [Medline].

  62. Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998 Feb 5. 338 (6):347-54. [Medline].

  63. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000 May 4. 342 (18):1301-8. [Medline].

  64. Petrucci N, De Feo C. Lung protective ventilation strategy for the acute respiratory distress syndrome. Cochrane Database Syst Rev. 2013 Feb 28. 2:CD003844. [Medline].

  65. Hickling KG, Henderson SJ, Jackson R. Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med. 1990. 16 (6):372-7. [Medline].

  66. Lunkenheimer PP, Rafflenbeul W, Keller H, Frank I, Dickhut HH, Fuhrmann C. Application of transtracheal pressure oscillations as a modification of "diffusing respiration". Br J Anaesth. 1972 Jun. 44 (6):627. [Medline].

  67. High-frequency oscillatory ventilation compared with conventional mechanical ventilation in the treatment of respiratory failure in preterm infants. The HIFI Study Group. N Engl J Med. 1989 Jan 12. 320 (2):88-93. [Medline].

  68. Ferguson ND, Cook DJ, Guyatt GH, Mehta S, Hand L, Austin P, et al. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med. 2013 Feb 28. 368 (9):795-805. [Medline].

  69. Young D, Lamb SE, Shah S, MacKenzie I, Tunnicliffe W, Lall R, et al. High-frequency oscillation for acute respiratory distress syndrome. N Engl J Med. 2013 Feb 28. 368 (9):806-13. [Medline].

  70. Arnold JH, Hanson JH, Toro-Figuero LO, Gutiérrez J, Berens RJ, Anglin DL. Prospective, randomized comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure. Crit Care Med. 1994 Oct. 22 (10):1530-9. [Medline].

  71. Gupta P, Green JW, Tang X, Gall CM, Gossett JM, Rice TB, et al. Comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure. JAMA Pediatr. 2014 Mar. 168 (3):243-9. [Medline].

  72. Adhikari NK, Burns KE, Friedrich JO, Granton JT, Cook DJ, Meade MO. Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis. BMJ. 2007 Apr 14. 334 (7597):779. [Medline].

  73. Curley MA, Hibberd PL, Fineman LD, Wypij D, Shih MC, Thompson JE, et al. Effect of prone positioning on clinical outcomes in children with acute lung injury: a randomized controlled trial. JAMA. 2005 Jul 13. 294 (2):229-37. [Medline].

  74. Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010 Sep 16. 363 (12):1107-16. [Medline].

  75. Willson DF, Chess PR, Notter RH. Surfactant for pediatric acute lung injury. Pediatr Clin North Am. 2008 Jun. 55 (3):545-75, ix. [Medline].

  76. Anzueto A, Baughman RP, Guntupalli KK, Weg JG, Wiedemann HP, Raventós AA, et al. Aerosolized surfactant in adults with sepsis-induced acute respiratory distress syndrome. Exosurf Acute Respiratory Distress Syndrome Sepsis Study Group. N Engl J Med. 1996 May 30. 334 (22):1417-21. [Medline].

  77. Czaja AS. A critical appraisal of a randomized controlled trial: Willson et al: Effect of exogenous surfactant (calfactant) in pediatric acute lung injury (JAMA 2005, 293: 470-476). Pediatr Crit Care Med. 2007 Jan. 8 (1):50-3. [Medline].

  78. Luchetti M, Ferrero F, Gallini C, Natale A, Pigna A, Tortorolo L, et al. Multicenter, randomized, controlled study of porcine surfactant in severe respiratory syncytial virus-induced respiratory failure. Pediatr Crit Care Med. 2002 Jul. 3 (3):261-268. [Medline].

  79. Walmrath D, Günther A, Ghofrani HA, Schermuly R, Schneider T, Grimminger F, et al. Bronchoscopic surfactant administration in patients with severe adult respiratory distress syndrome and sepsis. Am J Respir Crit Care Med. 1996 Jul. 154 (1):57-62. [Medline].

  80. Willson DF, Thomas NJ, Markovitz BP, Bauman LA, DiCarlo JV, Pon S, et al. Effect of exogenous surfactant (calfactant) in pediatric acute lung injury: a randomized controlled trial. JAMA. 2005 Jan 26. 293 (4):470-6. [Medline].

  81. Thomas NJ, Hollenbeak CS, Lucking SE, Willson DF. Cost-effectiveness of exogenous surfactant therapy in pediatric patients with acute hypoxemic respiratory failure. Pediatr Crit Care Med. 2005 Mar. 6 (2):160-5. [Medline].

  82. Furchgott RF, Jothianandan D. Endothelium-dependent and -independent vasodilation involving cyclic GMP: relaxation induced by nitric oxide, carbon monoxide and light. Blood Vessels. 1991. 28 (1-3):52-61. [Medline].

  83. Goldman AP, Tasker RC, Hosiasson S, Henrichsen T, Macrae DJ. Early response to inhaled nitric oxide and its relationship to outcome in children with severe hypoxemic respiratory failure. Chest. 1997 Sep. 112 (3):752-8. [Medline].

  84. Bronicki RA, Fortenberry J, Schreiber M, Checchia PA, Anas NG. Multicenter randomized controlled trial of inhaled nitric oxide for pediatric acute respiratory distress syndrome. J Pediatr. 2015 Feb. 166 (2):365-9.e1. [Medline].

  85. Bohn D. Nitric oxide in acute hypoxic respiratory failure: from the bench to the bedside and back again. J Pediatr. 1999 Apr. 134 (4):387-9. [Medline].

  86. Dobyns EL, Cornfield DN, Anas NG, Fortenberry JD, Tasker RC, Lynch A, et al. Multicenter randomized controlled trial of the effects of inhaled nitric oxide therapy on gas exchange in children with acute hypoxemic respiratory failure. J Pediatr. 1999 Apr. 134 (4):406-12. [Medline].

  87. Hirschl RB, Conrad S, Kaiser R, Zwischenberger JB, Bartlett RH, Booth F, et al. Partial liquid ventilation in adult patients with ARDS: a multicenter phase I-II trial. Adult PLV Study Group. Ann Surg. 1998 Nov. 228 (5):692-700. [Medline].

  88. Fedora M, Nekvasil R, Seda M, Klimovic M, Dominik P. Partial liquid ventilation in the therapy of pediatric acute respiratory distress syndrome. Bratisl Lek Listy. 1999 Sep. 100 (9):481-5. [Medline].

  89. Galvin IM, Steel A, Pinto R, Ferguson ND, Davies MW. Partial liquid ventilation for preventing death and morbidity in adults with acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev. 2013 Jul 23. 7:CD003707. [Medline].

  90. Zapol WM, Snider MT, Hill JD, Fallat RJ, Bartlett RH, Edmunds LH, et al. Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA. 1979 Nov 16. 242 (20):2193-6. [Medline].

  91. Gray BW, Haft JW, Hirsch JC, Annich GM, Hirschl RB, Bartlett RH. Extracorporeal life support: experience with 2,000 patients. ASAIO J. 2015 Jan-Feb. 61 (1):2-7. [Medline].

  92. Green TP, Timmons OD, Fackler JC, Moler FW, Thompson AE, Sweeney MF. The impact of extracorporeal membrane oxygenation on survival in pediatric patients with acute respiratory failure. Pediatric Critical Care Study Group. Crit Care Med. 1996 Feb. 24 (2):323-9. [Medline].

  93. Brown KL, Walker G, Grant DJ, Tanner K, Ridout DA, Shekerdemian LS, et al. Predicting outcome in ex-premature infants supported with extracorporeal membrane oxygenation for acute hypoxic respiratory failure. Arch Dis Child Fetal Neonatal Ed. 2004 Sep. 89 (5):F423-7. [Medline].

  94. Petrou S, Edwards L, UK Collaborative ECMO Trial. Cost effectiveness analysis of neonatal extracorporeal membrane oxygenation based on four year results from the UK Collaborative ECMO Trial. Arch Dis Child Fetal Neonatal Ed. 2004 May. 89 (3):F263-8. [Medline].

  95. Bennett CC, Johnson A, Field DJ, Elbourne D, UK Collaborative ECMO Trial Group. UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation: follow-up to age 4 years. Lancet. 2001 Apr 7. 357 (9262):1094-6. [Medline].

  96. Romay E, Ferrer R. Extracorporeal CO2 removal: Technical and physiological fundaments and principal indications. Med Intensiva. 2015 Sep 29. [Medline].

  97. Meduri GU, Headley AS, Golden E, Carson SJ, Umberger RA, Kelso T, et al. Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial. JAMA. 1998 Jul 8. 280 (2):159-65. [Medline].

  98. Steinberg KP, Hudson LD, Goodman RB, Hough CL, Lanken PN, Hyzy R, et al. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med. 2006 Apr 20. 354 (16):1671-84. [Medline].

  99. Tang BM, Craig JC, Eslick GD, Seppelt I, McLean AS. Use of corticosteroids in acute lung injury and acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care Med. 2009 May. 37 (5):1594-603. [Medline].

  100. Yehya N, Servaes S, Thomas NJ, Nadkarni VM, Srinivasan V. Corticosteroid exposure in pediatric acute respiratory distress syndrome. Intensive Care Med. 2015 Sep. 41 (9):1658-66. [Medline].

  101. Kangelaris KN, Sapru A, Calfee CS, Liu KD, Pawlikowska L, Witte JS, et al. The association between a Darc gene polymorphism and clinical outcomes in African American patients with acute lung injury. Chest. 2012 May. 141 (5):1160-9. [Medline].

 
Previous
Next
 
Eight-year-old girl with diagnosis of pneumonia. Chest radiograph on day of admission.
Fourteen-month-old boy with diagnosis of exacerbation of bronchopulmonary dysplasia. Chest radiograph on day of admission.
Eight-year-old girl with pneumonia and impending respiratory failure. Chest radiograph on day 2.
Fourteen-month-old boy with exacerbation of bronchopulmonary dysplasia and impending respiratory failure. Chest radiograph on morning of day 2.
Fourteen-month-old boy with exacerbation of bronchopulmonary dysplasia and respiratory failure. Chest radiograph on afternoon of day 2.
Fourteen-month-old boy with exacerbation of bronchopulmonary dysplasia, respiratory failure, and severe hypoxemia. Chest radiograph on evening of day 2.
Chest radiograph in 3-year-old girl who developed acute respiratory distress syndrome due to overwhelming gram-negative sepsis. Salient features include endotracheal tube; diffuse, bilateral infiltrates; air bronchograms on left side; and central venous catheter. Ratio of arterial oxygen tension to fraction of inspired oxygen at time of chest radiography was 100.
Chest radiograph demonstrates complication of acute respiratory distress syndrome. Patient presented with respiratory failure after near-drowning episode. Peak inspiratory pressures were 40 cm water. Patient had sudden desaturation and decreased bilateral air entry, as well as cool peripheries and decreased blood pressure. Needle evacuation of both pleural spaces confirmed pleural air. Chest tubes were placed, with immediate improvement in clinical status. Pulmonary status continued to deteriorate; high-frequency oscillatory ventilation was given. Patient subsequently required second chest tube on left side.
Chest CT in 6-month-old male infant with newly diagnosed cystic fibrosis. Patient was intubated for respiratory failure and subsequently developed acute respiratory distress syndrome. Image demonstrates numerous cystic and bronchiectatic areas. Note dorsal distribution of atelectasis, particularly on right side.
Typical pressure-volume curve may provide information regarding lung compliance, lung hysteresis, and critical opening and closing pressures. Evidence of pulmonary overdistention may also be observed.
Subcutaneous emphysema and pneumothorax.
Table.
Study Zimmerman JJ et al[31] Rubenfield GD et al[27]
Age in years 0.5 to 15 15 through 19 75 through 84
Incidence per 100,000 person-years 12.8 16 306
Mortality 18% 24% 60%
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.