Long-term sequelae in children surviving adult respiratory distress syndrome

Nine children surviving severe adult respiratory distress syndrome were studied 0.9 to 4.2 years after the acute illness. They had received artificial ventilation for a mean of 9.4 days, with an Fio2 greater than 0.5 during a mean time of 34 hours and maximal positive end expiratory pressure levels in the range of 8 to 20 cm H2O. Three children had recurrent respiratory symptoms (moderate exertional dyspnea and cough), and two had evidence of fibrosis on chest radiographs. All patients had abnormal lung function; the most prominent findings were ventilation inequalities, as judged by real-time moment ratio analysis of multibreath nitrogen washout curves (abnormal in eight of nine patients) and hypoxemia (seven of nine). Lung volumes were less abnormal; one patient had restrictive and two had obstructive disease. A significant correlation between intensive care measures (Fio2 greater than 0.5 in hours and peak inspiratory plateau pressure) and lung function abnormalities (moment ratio analysis and hypoxemia) was found. A possibly increased susceptibility of the pediatric age group to the primary insult or respiratory therapy of adult respiratory distress syndrome is suggested.     

Persistent low plasma vitamin E levels in premature infants surviving respiratory distress syndrome

Plasma vitamin E levels were determined serially in preterm infants surviving respiratory distress syndrome (RDS) and in premature infants without RDS (control). Vitamin E intakes of the RDS and control infant group were not significantly different. The results of the study show that preterm infants surviving RDS have a persistent low plasma vitamin E level throughout the first 8 weeks of life. In contrast, in premature infants without RDS the plasma vitamin E level gradually increases to the adult level throughout the first 8 weeks of life. It is concluded that data on plasma vitamin E levels in premature infants with and without RDS should not be pooled together to obtain reference values. It is further suggested that premature infants with RDS might need more supplemental vitamin E than premature infants without RDS.Abbreviation RDS respiratory distress syndrome     

Current concepts in adult respiratory distress syndrome in children

Acute respiratory distress syndrome (ARDS) is an acute form of severe alveolar-capillary injury that evolves after a direct or indirect lung insult. It begins as noncardiogenic pulmonary edema and develops into a neutrophilic alveolitis, and, later, pulmonary fibrosis. Mortality remains high among children with ARDS, particularly when serious underlying conditions co-exist, sepsis occurs, and when there is multi-organ failure. Lung function improves with time among survivors, but pulmonary fibrosis may persist. Advances in the care of children with ARDS include the use of lung-protective ventilator strategies, permissive hypercapnia, inhaled nitric oxide, high-frequency ventilation, and extra-corporeal life support. These approaches reduce ventilator-associated lung injury and may improve survival when used in combination with one another. Interventions that reduce alveolar inflammation, enhance alveolar fluid removal, and reduce pulmonary fibrosis will further improve survival and recovery from ARDS in the future.     

急性呼吸窘迫综合征患儿肺力学特点

急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的病因不一,发病机制各有所异,病情进展过程中肺力学的改变存在个体差异。顺应性、压力、容量等的变化与病因、病情轻重、年龄等密切相关。正确采用肺保护性通气策略、合理调节呼吸机参数、减少呼吸机相关性肺损伤是提高ARDS救治成功率的关键。因此,在ARDS机械通气治疗中必须高度注意患儿肺力学的特点和变化。     

Acute respiratory distress syndrome

Background  

Acute respiratory distress syndrome (ARDS) is a common diagnosis among children admitted to pediatric intensive care units. This heterogeneous disorder has numerous pulmonary and non-pulmonary causes and is associated with a significant risk of mortality. Many supportive therapies exist for ARDS.     

Management of respiratory distress syndrome

Respiratory distress syndrome is the most common pathology of preterm infants managed in neonatal intensive care units worldwide. Advances in neonatal intensive care, prenatal interventions, especially corticosteroid therapy, and postnatal respiratory support have considerably increased the survival of extremely premature infants. Despite these advances, epithelial lung injury and inflammation secondary to surfactant deficiency and as a consequence of mechanical ventilation ultimately leading to bronchopulmonary dysplasia has not significantly reduced. Animal studies have confirmed that the pathological cascade of inflammation is initiated within the first few breaths of life, more so in a surfactant-deficient lung. Hence early management is aimed at minimizing lung injury, starting in the delivery suite. Although a number of different modalities of ventilation are available for ongoing support, the principle is to administer controlled ventilation, avoiding overinflation, and to give just enough end expiratory pressure to prevent collapse of surfactant-deficient alveoli. Non-invasive ventilation is an invaluable tool both in the treatment of mild-to-moderate RDS and the prevention of post-extubation respiratory failure. Supportive treatment contributes equally to the outcome.     

Pathophysiology of respiratory distress syndrome

Respiratory distress syndrome (RDS) is a major cause of neonatal mortality and morbidity, especially in preterm infants. Its aetiology includes developmental immaturity of the lungs, particularly of the surfactant synthesizing system. Surfactant is produced, stored and recycled by type II pneumocytes and is detectable from about 24 weeks’ gestation. It is a mixture of phospholipids, neutral lipids and proteins and is spread as a film over the alveolar surface to lower surface tension and to prevent alveolar collapse. The resulting clinical correlates of RDS can be predicted from the immature lung structure and atelectasis which occur due to surfactant deficiency. Various clinical factors are known to dysregulate surfactant production and function, leading to the development of RDS. Apart from preventing the incidence of prematurity, antenatal steroids and prophylactic surfactant are of proven benefit in reducing the incidence of RDS.     

小儿ARDS临床流行病学研究进展

急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)1967年由Ashbaugh首次报道,因其症状、病理均与早产儿呼吸窘迫综合征(RDS)相似,最初命名为成人呼吸窘迫综合征(adult respiratory distress syndrome,ARDS)。但该病非成人专有,小儿亦可出现,且Ashbaugh首次报道的     

无创通气支持在儿童急性呼吸窘迫综合征中的应用

急性呼吸窘迫综合征（ARDS）是儿科临床常见危重症,在儿科重症患者中具有较高的发病率和病死率。无创通气因其自身特点已成为ARDS救治的常用支持手段,该文就儿童ARDS无创通气支持研究现状进行综述。     

Minimizing the risk of respiratory distress syndrome

Respiratory distress syndrome, or hyaline membrane disease, remains one of the most significant causes of neonatal morbidity and mortality, despite advances in perinatal care. It is a condition predominantly affecting premature infants, with an incidence inversely related to gestational age. Whilst many infants will improve within a few days, more severely affected babies are at risk of developing chronic lung disease, and a range of extrapulmonary complications. Minimizing the risk of respiratory distress syndrome requires a combination of preventative strategies prior to and in the immediate aftermath of delivery and a balanced approach to treatment of established disease. The use of antenatal steroids and pulmonary surfactant have revolutionized perinatal medicine, however a number of controversies still exist for both treatments such as optimal dosing, timing, and repeat courses. This article reviews the current evidence for these treatments, as well as over viewing the other essential antenatal and perinatal concerns faced when managing an infant at risk of respiratory distress syndrome.     

Inhaled nitric oxide therapy for acute respiratory distress syndrome in children

The aim of this study was to evaluate the effects of inhaled nitric oxide (iNO) therapy on oxygenation and mortality in children with acute respiratory distress syndrome (ARDS). Thirty-three children with ARDS and an arterial SatO2 <88% despite mechanical ventilation were analyzed. Patients in the iNO group were prospectively enrolled and treated with conventional therapy plus iNO. The control group consisted of retrospectively analyzed patients treated only with conventional therapy. A significant increase in PaO2/FiO2 ratio (25.6%) and decrease in oxygenation index (19.5%) was observed after 4 h of iNO treatment, when compared to baseline values. A positive response to iNO was detected in 69% of patients, and there was no difference between pulmonary and extrapulmonary ARDS. There was no difference in mortality and duration of mechanical ventilation between iNO and control group.     

新生儿呼吸窘迫综合征的诊治

新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS),又称新生儿肺透明膜病(hyaline membrane disease,HMD),是新生儿死亡的主要原因之一.RDS主要是因为缺乏肺表面活性物质(pulmonary surfactant,PS)引起.     

Adult-type respiratory distress syndrome in children. Experience with seven cases

Adult respiratory distress syndrome (ARDS) is not well recognized in children. We report seven individuals, ranging in age from 1.5 to 16 years. The clinical picture of ARDS reached a peak in 72 hours from admission and was associated with a 28.5 per cent death rate (2/7). In no case was an organism isolated, either from bronchial washings via a flexible bronchoscope or from open lung biopsy specimen. ARDS is characterized by severe damage to the alveolar-capillary unit and probably inadequate production of lung surfactant, resulting in severe hypoxia, hypoxemia, intrapulmonary shunting, and marked decline in pulmonary compliance. The prognosis remains poor in the pediatric age group. The pathophysiology of this entity is outlined, with guidance for monitoring and therapy.