Abstract
Acute respiratory distress Syndrome (ARDS) was first described in 1967 by Asbough et al. as a clinical Syndrome that occurs 24 to 48 hours after a direct or indirect hing injury [1]. It is characterised by dyspnea, tachypnea, hypoxemia refractory to oxygen therapy, decreased lung compliance, and diffuse alveolar infiltrates on ehest X-ray. ARDS is a rare disorder in childhood. The ineidence varies from 0.8 to 4.4% among all admissions to the pediatric ICU [2–6]. Pediatric literature reports a mortality rate for children with ARDS higher than 50% [7, 8]. An alveolar-arterial oxygen tension difference (P(A-a)02) > 470 mmHg and mean airway pressure (Paw) > 23 cm H20 are associated with poor outcome [5, 8]. Whereas the use of extracorporeal membrane oxygenation (ECMO) significantly increased the survival rate of neonates with severe acute respiratory failure up to 85%, the world wide mortality rate of children with severe ARDS and extracorporeal lung support is still 50% (ELSO report 07/95) [9]. In 1994 the Michigan ECMO group reported a survival rate higher than 80% in children with ARDS and ECMO [10]. Recently, a variety of therapeutic options has been introduced to treat patients with severe ARDS. These novel therapies include pressure controlled mechanical Ventilation with peak pressure limitation < 40 cm H20 [11], permissive hypercapnia [12], inhaled nitric oxide (NO) [13], Surfactant therapy [14], and high frequency oscillation (HFO) [15].
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References
Asbough DG, Bigelow DB, Petty TL et al (1967) Acute respiratory distress in adults. Lancet ii:319–323
Holbrook PR, Taylor G, Pollack MM et al (1980) Adult respiratory distress syndrome in children. Pediatr Clin North Am 27:677–685
Pfenninger J, Gerber A, Tschappeler H et al (1982) Adult respiratory distress syndrome in children. J Pediatr 101:352–357
Lyrene RK, Truog WE (1981) Adult respiratory distress syndrome in a pediatric intensive care unit: Predisposing conditions, clinical course, and outcome. Pediatrics 67:790–795
Timmons OD, Dean JM, Vernon DD (1991) Mortality rates and prognostic variables in children with adult respiratory distress syndrome. J Pediatr 119:896–899
DeBruin W, Notterman DA, Magid M et al (1992) Acute hypoxemic respiratory failure in infants and children: Clinical and pathologic characteristics. Crit Care Med 20:1223–1234
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: 169–180
Davis SL, Furman DP, Costarino AT et al (1993) Adult respiratory distress syndrome in children: Associated disease, clinical course, and predictors of death. J Pediatr 123:35–45
Tracy TF, DeLosh T, Stolar CJH (1995) The registry of extracorporeal life support organization. In: Zwischenberger JB, Bartlett RH (eds). Extracorporeal cardiopulmonary support in critical care. ELSO, Ann Arbor, pp 251–260
Moler FW, Custer JR, Bartlett R et al (1994) Extracorporeal life support for severe pediatric respiratory failure: An updated experience 1991–1993. J Pediatr 124:875–880
Slutsky AS (1994) Consensus conference on mechanical ventilation-January 28–30, 1993 at Northbrook, Illinois, USA Part I. Intensive Care Med 20:64–79
Hickling KG, Henderson SJ, Jackson R (1990) Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med 16:372–377
Rossaint R, Falke KJ, Lopez F et al (1993) Inhaled nitric oxide in adult respiratory distress syndrome. N Engl J Med 328:399–405
Lewis JF, Jobe AH (1993) Surfactant and the adult respiratory distress syndrome. Am Rev Respir Dis 147:218–233
Arnold JH, Hanson JH, Toro-Figuero LO et al (1994) Prospective, randomized comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure Crit Care Med 22:1530–1539
Zobel G, Kuttnig M, Trop M et al (1990) A respiratory severity index for children with ARDS. Clin Intensive Care 1:17–21
Murray JF, Matthay MA, Luce JM et al (1988) An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 138:720–723
Tamburro RF, Bugnitz MC, Stidham GL (1991) Alveolar-arterial oxygen tension gradient as a predictor of outcome in patients with nonneonatal pediatric respiratory failure. J Pediatr 119:935–938
Ortiz RM, Cilley RE, Bartlett R (1987) Extracorporeal membrane oxygenation in pediatric respiratory failure. Pediatr Clin North Am 34:39–46
Rivera RA, Butt W, Shann F (1990) Predictors of mortality in children with respiratory failure: Possible indications for ECMO. Anaesth Intensive Care 18:385–389
Pollack MM, Ruttimann UE, Getson PR et al (1988) Pediatric Risk of Mortality (PRISM) score. Crit Care Med 16:1110–1116
Keene AR, Cullen DJ (1983) Therapeutic Intervention scoring system: Update 1983. Crit Care Med 11:1–3
Wikinson JD, Pollack MM, Ruttimann UE et al (1986) Outcome of pediatric patients with multiple organ system failure. Crit Care Med 14:271–274
Bone RC (1991) Let’s agree on terminology: Definitions of sepsis. Crit Care Med 19:973–976
Matthay MA, Folkesson HG, Campagna A et al (1993) Alveolar epithelial barrier ana acute lung injury. New Horizons 1:613–622
Demling RH, Knox JB (1993) Basic concepts of lung function and dysfunction: Oxygenation, ventilation, and mechanics. New Horizons 1:362–370
Kolobow T, Moretti MP, Fumagalli R et al (1987) Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation. An experimental study. Am Rev Respir Dis 135:312–315
Dreyfuss D, Soler P, Basset G et al (1988) High inflation pressure pulmonary edema: Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis 137:1159–1164
Long W, Corbet A, Cotton R et al (1991) A controlled trial of synthetic surfactant in infants weighing 1250 g or more with respiratory distress syndrome. The American Exosurf neonatal study group I, and the Canadian Exosurf neonatal study group. N Engl J Med 352:1696–1703
Auten RL, Notter RH, Kendig JW et al (1991) Surfactant treatment of full-term newborns with respiratory failure. Pediatrics 87:101–107
McBrien M, Katumba JJ, Muktar AI (1993) Artificial surfactant in the treatment of near drowning. Lancet 342:1485–1486
Slater AJ, Nichani SH, Macrae D et al (1995) Surfactant adjunctive therapy for Pneumocystis carinii pneumonitis in an infant with acute lymphoblastic leukemia. Intensive Care Med 21:261–263
Gommers D, Lachmann B (1993) Surfactant therapy: does it have a role in adults? Clinical Int Care 4:284–295
Spragg RG, Gilliard N, Richman PM et al (1994) Acute effects or a single uose oi porcinie surfactant on patients with adult respiratory distress syndrome (ARDS). Chest 105:195–202
Tashiro K, Li WZ, Yamada K et al (1995) Surfactant replacement reverses respiratory failure induced by intratracheal endotoxin in rats. Crit Care Med 23:149–156.
Gregory TJ, Gadek JE, Weiland JE et al (1994) Survanta supplementation in patients with acute respiratory distress syndrome (ARDS). Am J Respir Crit Care Med 149:A567 (Abstract)
Gommers D, Houmes RJM, Olsson SG et al (1994) Exogenous surfactant and nitric oxide have a synergistic effect in improving respiratory failure. Am J Respir Crit Care Med 149:A568 (Abstract)
Kinsella JP, Abmann SH (1995) Recent developments in the pathophysiology and treatment of persistent pulmonary hypertension. J Pediatr 126:853–864
Zapol WM, Snider MT, Rie MA et al (1985) Pulmonary circulation during adult respiratory distress syndrome. In: Zapol WM, Falke KJ (eds) Acute respiratory failure. Marcel Dekker, New York, pp 241–270
Radermacher P, Santak B, Wust HJ et al (1990) Prostacyclin for the treatment of pulmonary hypertension in the adult respiratory distress syndrome: Effects on pulmonary capillary wedge pressure and ventilation-perfusion distributions. Anesthesiology 72:238–244
Zapol WM, Hurford WE (1993) Inhaled nitric oxide in the adult respiratory distress syndromie and other lung diseases. New Horizons 1:638–650
Abman SH, Griebel JL, Parker DK et al (1994) Acute effects of inhaled nitric oxide in children with severe hypoxemic respiratory failure. J Pediatr 124:881–888
Nelson LD, Choi SC (1992) Kinetic therapy in critically ill trauma patients. Clinical Int Care 3:248–252.
Gentiello L, Thompson DA, Tonnesen AS et al (1988) Effect of rotating bed on the incidence of pulmonary complications in critically ill patients. Crit Care Med 16:783–786
Murai DT, Grant JW (1994) Continuous oscillation therapy improves the pulmonary outcome of intubated newborns: Results of a prospective, randomized, controlled trial. Crit Care Med 22:1147–1154
Nahum A, Marini JJ (1994) Tracheal gas insufflation as an adjunct to conventional ventilation. In: Vincent JL (ed) Yearbook of intensive care and emergency medicine. Springer, Berlin Heidelberg New York, pp 511–523
Fuhrman BP (1993) Perfluorocarbon liquids and respiratory support. Crit Care Med 21:951
Leach CL, Fuhrman BP, Morin FC et al (1993) Perfluorocarbon-associated gas exchange (partial liquid ventilation) in respiratory distress syndrome: A prospective, randomized, controlled study. Crit Care Med 21:1270–1278
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Zobel, G., Rödl, S., Urlesberger, B. (1997). Recent Therapeutic Strategies for Children with Acute Respiratory Distress Syndrome. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-2296-6_35
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DOI: https://doi.org/10.1007/978-88-470-2296-6_35
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