Adult respiratory distress syndrome in children

Clinical, radiological, and pathologic data for nine children with adult respiratory distress syndrome (ARDS) were reviewed. The children ranged in age from 7 months to 15 years (mean age, 7.4 yrs). Underlying diseases and precipitating events included sepsis, pneumonia, near drowning, aspiration pneumonia, central nervous system trauma, and malignancy. All patients had the rapid onset of diffuse bilateral lung opacification, required assisted ventilation for periods of 5-86 days (mean, 25.2 days), and received high levels of inspired oxygen for 2-41 days (mean, 12.7 days). Eight patients manifested air leak complications; these problems persisted until the patients died or were weaned from the respirator. Five of the nine patients died. Autopsy in three patients demonstrated alveolar duct fibrosis characteristic of the late proliferative phase of ARDS and consistent with oxygen toxicity. Two survivors demonstrated mild restrictive changes on follow-up pulmonary function tests and showed persistent linear densities on chest radiographs.