Adult Respiratory Distress Syndrome (ARDS) in Infants and Children

  • J. Pfenninger
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine 1994 book series (YEARBOOK, volume 1994)


The term adult respiratory distress syndrome (ARDS) has been coined nearly 20 years ago by Petty and Ashbaugh: adult, because it was encountered in this age group, and RDS in analogy to the idiopathic RDS (or hyaline membrane disease) in premature infants [1]. Since then, the name ARDS has become widely accepted, although a number of authors have questioned its reality as a discrete entity [2]. The syndrome is characterized by the presence of an acute direct or indirect insult to the lungs (Table 1), followed within 72 h by respiratory distress, arterial hypoxemia, reduced pulmonary compliance and diffuse alveolar infiltrates on chest radiography, sparing the costophrenic angles. The main pathogenic mechanism triggering ARDS is the injury to the alveolo-capillary membrane leading to an abnormal permeability for plasma and even formed blood elements (permeability pulmonary edema), and abnormal function of pulmonary surfactant. (It is out of the scope of this chapter to discuss the pathogenesis of disrupted alveolo-capillary function.) Nowadays, we recognize that this rather liberal definition of ARDS did not include strict hemodynamic criteria, and that for this reason patients with fluid overload might have been included in earlier series. With the advent of the possibility to catheterize the pulmonary artery in the ICU and to estimate indirectly left atrial pressure, it seemed that a clear distinction between cardiogenic and permeability pulmonary edema should be easily possible [3]. However, flow-directed balloon-tipped catheters as described by Swan and Ganz have their pitfalls and complications, and interpretation of data is not always straightforward [4]. Another possibility in distinguishing cardiogenic and permeability pulmonary edema is by analysis of the tracheobronchial aspirate for protein content and protein composition in relation to the plasma [5].


Pulmonary Edema Adult Respiratory Distress Syndrome High Tidal Volume Hyaline Membrane Disease Arterial Hypoxemia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Petty TL, Ashbaugh DG (1971) The adult respiratory distress syndrome. Chest 60: 233239Google Scholar
  2. 2.
    Murray JF (1975) The adult respiratory distress syndrome (may it rest in pease). Am Rev Respir Dis 111: 716–718PubMedGoogle Scholar
  3. 3.
    Swan HJC, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D (1970) Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med 283: 447–451PubMedCrossRefGoogle Scholar
  4. 4.
    Morris AH, Chapman RH, Gardner RM (1985) Frequency of wedge pressure errors in the ICU. Crit Care Med 13: 705–708PubMedCrossRefGoogle Scholar
  5. 5.
    Sprung CL, Rackow EC, Fein IA, Jakob AJ, Isikoff SK (1981) The spectrum of pulmonary edema. Am Rev Respir Dis 124: 718–722PubMedGoogle Scholar
  6. 6.
    Murray JF, Matthay MA, Luce JM, Flick MR (1988) An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 138: 720–723PubMedGoogle Scholar
  7. 7.
    Bachofen M, Weibel ER (1977) Alterations of the gas exchange apparatus in adult respiratory insufficiency associated with septicemia. Am Rev Respir Dis 166: 589–615Google Scholar
  8. 8.
    Holbrook PR, Taylor G, Pollack MM, Fields AI (1980) Adult respiratory distress syndrome in children. Pediatr Clin North Am 27: 677–685PubMedGoogle Scholar
  9. 9.
    Lyrene RK, Truog WE (1981) Adult respiratory distress syndrome in a pediatric intensive care unit: Predisposing conditions, clinical course, and outcome. Pediatrics 67: 790–795Google Scholar
  10. 10.
    Pfenninger J, Gerber A, Tschäppeler H, Zimmermann A (1982) Adult respiratory distress syndrome in children. J Pediatr 101: 352–357PubMedCrossRefGoogle Scholar
  11. 11.
    Faix RG, Viscardi RM, Di Pietro MA, Nicks JJ (1989) Adult respiratory distress syndrome in full-term newborns. Pediatrics 83: 971–972PubMedGoogle Scholar
  12. 12.
    Pfenninger J, Tschaeppeler H, Wagner BP, Weber J, Zimmermann A (1991) The paradox of adult respiratory distress syndrome in neonates. Pediatr Pulmonol 10: 18–24PubMedCrossRefGoogle Scholar
  13. 13.
    De Bruin W, Notterman DA, Magid M, Godwin T, Johnston S (1992) Acute hypoxemic respiratory failure in infants and children: Clinical and pathologic characteristics. Crit Care Med 20: 1223–1234Google Scholar
  14. 14.
    Pfenninger J, Tschaeppeler H (1990) Adult respiratory distress syndrome in full-term newborns. Pediatrics 85: 1131–1132PubMedGoogle Scholar
  15. 15.
    Royall JA, Levin DL (1988) Adult respiratory distress syndrome in pediatric patients. I. Clinical aspects, pathophysiology, pathology, and mechanisms of lung injury. J Pediatr 112: 169–180Google Scholar
  16. 16.
    Timmons OD, Dean JM, Vernon DD (1991) Mortality rates and prognostic variables in children with adult respiratory distress syndrome. J Pediatr 119: 896–899PubMedCrossRefGoogle Scholar
  17. 17.
    Fanconi S, Kraemer R, Weber J, Tschaeppeler H, Pfenninger J (1985) Long-term sequelae in children surviving adult respiratory distress syndrome. J Pediatr 106: 218–222PubMedCrossRefGoogle Scholar
  18. 18.
    Royall J, Levin DL (1988) Adult respiratory distress syndrome in pediatric patients. II. Management. J Pediatr 112: 335–347Google Scholar
  19. 19.
    Bone RC, Slotman G, Maunder R, et al (1989) Prostaglandin El Study Group: Randomized double-blind, multicenter study of prostaglandin El in patients with the adult respiratory distress syndrome. Chest 96: 114–119Google Scholar
  20. 20.
    Wood LDH, Prewitt RM (1981) Cardiovascular management in hypoxemic respiratory failure. Am J Cardiol 47: 963–972PubMedCrossRefGoogle Scholar
  21. 21.
    Haupt MT (1988) Pathologic oxygen supply dependency in the adult respiratory distress syndrome and sepsis. Intensive Crit Care Digest 7: 12–14Google Scholar
  22. 22.
    Dreyfuss D, Soler P, Basset G, Saumon G (1988) High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis 137: 1159–1164Google Scholar
  23. 23.
    Davis JM, Penny DP, Notter RH, Metlay L, Dickerson B, Shapiro DL (1989) Lung injury in the neonatal piglet caused by hyperoxia and mechanical ventilation. J Appl Physiol 67: 1007–1012PubMedGoogle Scholar
  24. 24.
    Hickling KG (1990) Ventilatory management of ARDS: Can it affect outcome? Intensive Care Med 16: 219–226PubMedCrossRefGoogle Scholar
  25. 25.
    Mancebo J (1992) PEEP, ARDS, and alveolar recruitment. Intensive Care Med 18: 383385Google Scholar
  26. 26.
    Froese AB, Bryan AC (1974) Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology 41: 242–255PubMedCrossRefGoogle Scholar
  27. 27.
    Moler FW, Custer JR, Bartlett RH, et al (1992) Extracorporeal life support for pediatric respiratory failure. Crit Care Med 20: 1112–1118PubMedCrossRefGoogle Scholar
  28. 28.
    Clemmer T, Morris A, Suchyta M, et al (1992) Extracorporeal support does not improve ARDS survival. Crit Care Med 20: S61CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • J. Pfenninger

There are no affiliations available

Personalised recommendations