Acute Respiratory Distress Syndrome

  • Frank A. Maffei
  • Neal J. Thomas


Clinicians have long known the severe pulmonary complications that can accompany life-threatening illness or injury. In 1967, Ashbaugh and colleagues described what has now become known as the acute respiratory distress syndrome (ARDS). Their initial description of the syndrome in civilian patients was further appreciated in victims of nonthoracic trauma during the Vietnam War. ARDS has been known by other terms including: Da Nang lung, shock lung, noncardiogenic pulmonary edema and wet lung. ARDS is well described in pediatric patients and therefore “acute respiratory distress syndrome” should be used in place of “adult respiratory distress syndrome”. In 1994, a European-American Consensus Conference formalized a working definition for both acute lung injury and the acute ­respiratory distress syndrome (Table 24-1). While these definitions are still broadly utilized, many in pediatrics feel that oxygenation index [(mean airway pressure X Fi02) / PaO2] is a more accurate marker of true oxygenation defect.


Lung Injury Acute Respiratory Distress Syndrome Functional Residual Capacity Acute Respiratory Distress Syndrome Patient Conventional Mechanical Ventilation 
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Suggested Readings

  1. Amato MB, Barbas CS, Medeiros DM, et al. Effect of a protective-ventilation strategy on mortality in ARDS. N Engl J Med. 1998; 338:347–54.PubMedCrossRefGoogle Scholar
  2. Arnold JH, Hanson JH, Toro-Figuero LO, et al. Prospective randomized comparison of HFOV and conventional mechanical ventilation in pediatric respiratory failure. Crit Care Med. 1994;22: 1530–9.PubMedGoogle Scholar
  3. Benjamin M, Tang B, Craig JC, et al. Use of corticosteroids in acute lung injury and acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care Med. 2009;37:1594–603.CrossRefGoogle Scholar
  4. Bernard GR, Artigas A, Brigham KL, et al. The American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818–24.PubMedGoogle Scholar
  5. Brower RG, Ware LB, Berthiaume T, Matthay MA. Treatment of ARDS. Chest. 2001;120:1347–67.PubMedCrossRefGoogle Scholar
  6. 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;294(2):229–37.PubMedCrossRefGoogle Scholar
  7. Diaz JV, Brower R, Calfee CS, et al. Therapeutic strategies for severe acute lung injury. Crit Care Med. 2010;38:1644–50.PubMedCrossRefGoogle Scholar
  8. Gattinoni L, Pelosi P, Sutter P, et al. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease: different syndromes? Am J Respir Crit Care Med. 1998;158:3–11.PubMedGoogle Scholar
  9. Gattinoni L, Caeroni P, Pelosi P, et al. What has computed tomography taught us about acute respiratory distress syndrome? Am J Respir Crit Care Med. 2001;164:1701–11.Google Scholar
  10. Luciano G, Tognoni G, Presenti G, et al. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med. 2001;345:568–73.CrossRefGoogle Scholar
  11. Matthews BD, Noviski N. Management of oxygenation in pediatric acute hypoxemic respiratory failure. Pediatr Pulmonol. 2001;32:459–70.PubMedCrossRefGoogle Scholar
  12. Meduri GU, Headley AS, Golden E, et al. Effect of prolonged methylprednisolone therapy in unresolving ARDS: a randomized controlled trial. JAMA. 1998;280:159–65.PubMedCrossRefGoogle Scholar
  13. Papazian L, Forel JM, Gacouin A, et al. for the ACURASYS Study Investigators. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363:1107–16.Google Scholar
  14. Priestly M, Helfaer M. Approaches in the management of acute respiratory failure in children. Curr Opin Pediatr. 2004;16:293–8.CrossRefGoogle Scholar
  15. Rhoades RA, Tawner GA. Medical physiology. 1st ed. Baltimore: Williams and Wilkins; 1995.Google Scholar
  16. Redding GJ. Current concepts in ARDS in children. Curr Opin Pediatr. 2001;13:261–6.PubMedCrossRefGoogle Scholar
  17. Sokol J, Jacobs SE, Bohn D. Inhaled nitric oxide for acute hypoxemic respiratory failure in children and adults. Cochrane Database Syst Rev. 2003;1:CD002787.PubMedGoogle Scholar
  18. Steinberg K, Hudson L, Goodman R, et al. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med. 2006;354:1671–84.PubMedCrossRefGoogle Scholar
  19. Timmons OD, Dean JM, Vernon DD. Mortality rates and prognostic variables in children with ARDS. J Pediatr. 1991;119:896–9.PubMedCrossRefGoogle Scholar
  20. Vaughan DJ, Brogan T. Acute respiratory distress syndrome. eMedicine Journal 2001;2 Accessed 1 May 2011.
  21. Wiedemann HP, Wheeler AP, Bernard GR, et al. for the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354:2564–75.Google Scholar
  22. 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;293:470–6.PubMedCrossRefGoogle Scholar
  23. Wood LDH, Prewitt RM. Cardiovascular management of hypoxemic respiratory failure. Am J Cardiol. 1981;47:963–72.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  • Frank A. Maffei
    • 1
  • Neal J. Thomas
    • 2
  1. 1.Pediatric Critical Care Medicine, Department of Pediatrics, Geisinger Medical CenterTemple University School of Medicine, Janet Weis Children’s HospitalDanvilleUSA
  2. 2.Pediatric Critical Care Medicine, Department of PediatricsPenn State College of Medicine, Penn State Hershey Children’s HospitalHersheyUSA

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