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Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome (ARDS)
Published on: April 7, 2021
Acute respiratory failure
James Schneider1, Todd Sweberg
1Division of Critical Care Medicine, Hofstra North Shore-LIJ School of Medicine, Cohen Children's Medical Center of New York, North Shore Long Island Jewish Health System, 269-01 76th Avenue, New Hyde Park, NY 11040, USA. jschneide2@nshs.edu
Insights
Critically ill children frequently experience acute respiratory failure, often due to pneumonia or bronchiolitis. While noninvasive monitoring is preferred, long-term respiratory compromise can occur after recovery from acute lung injury/acute respiratory distress syndrome.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Pulmonology
Background:
- Acute respiratory failure is prevalent in critically ill children.
- Developmental variations in the pediatric respiratory system increase susceptibility.
- Pneumonia and bronchiolitis are the leading causes of respiratory failure in children.
Purpose of the Study:
- To review the physiologic basis of acute respiratory failure in children.
- To discuss current therapeutic options for pediatric acute respiratory failure.
- To highlight the evolution of respiratory monitoring in pediatric critical care.
Main Methods:
- Review of existing literature on pediatric acute respiratory failure.
- Discussion of diagnostic and monitoring techniques, emphasizing noninvasive methods.
- Analysis of outcomes and long-term sequelae in children with ALI/ARDS.
Main Results:
- Clinical examination remains crucial despite advancements in monitoring.
- Noninvasive monitoring has largely replaced invasive tests.
- Children with ALI/ARDS generally have better outcomes than adults, but specific therapies require further research.
- Long-term respiratory compromise is common after recovery from ALI/ARDS.
Conclusions:
- Understanding the unique physiology of pediatric respiratory failure is essential for effective management.
- Noninvasive monitoring and clinical assessment are key components of care.
- While outcomes are often better than in adults, further research into pediatric-specific therapies is needed.
- Children recovering from ALI/ARDS may experience persistent respiratory issues.
Abstract:
Acute respiratory failure is common in critically ill children, who are at increased risk of respiratory embarrassment because of the developmental variations in the respiratory system. Although multiple etiologies exist, pneumonia and bronchiolitis are most common. Respiratory system monitoring has evolved, with the clinical examination remaining paramount. Invasive tests are commonly replaced with noninvasive monitors. Children with ALI/ARDS have better overall outcomes than adults, although data regarding specific therapies are still lacking. Most children will have some degree of long-term physiologic respiratory compromise after recovery from ALI/ARDS. The physiologic basis for respiratory failure and its therapeutic options are reviewed here.
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