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Updated: Aug 31, 2025
Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
Published on: April 7, 2021
Whole pulmonary assessment 1 year after paediatric acute respiratory distress syndrome: prospective multicentre study
Véronique Nève1,2,3, Ahmed Sadik4, Laurent Petyt5
1Pulmonary Function Testing Department, CHU Lille, 2 avenue Oscar Lambret, 59000, Lille, France. veronique.neve@chru-lille.fr.
Insights
Children surviving pediatric acute respiratory distress syndrome (p-ARDS) often experience respiratory symptoms and lung abnormalities one year after intensive care unit discharge. A systematic pulmonary assessment is crucial for these survivors.
Area of Science:
- Pediatric pulmonology
- Critical care medicine
- Radiology
Background:
- Long-term pulmonary sequelae after pediatric acute respiratory distress syndrome (p-ARDS) are not well understood.
- Previous studies have not fully characterized 1-year thoracic computed tomography (CT) sequelae in pediatric ARDS survivors.
Purpose of the Study:
- To determine pulmonary abnormalities in child survivors of pulmonary (p-ARDS) and extra-pulmonary ARDS (ep-ARDS) one year after pediatric intensive care unit discharge (PICUD).
Main Methods:
- Prospective multicenter study involving 39 pediatric ARDS survivors assessed one year post-PICUD.
- Assessments included respiratory symptom questionnaires, thoracic CT scans, and pulmonary function tests (PFTs).
Main Results:
- 74% of p-ARDS survivors reported respiratory symptoms or required treatment, compared to 13% of ep-ARDS survivors.
- CT abnormalities were seen in 60% of p-ARDS and 50% of ep-ARDS cases; diffuse abnormalities were exclusive to p-ARDS.
- 86% of patients had PFT abnormalities, with 20% showing significant issues, all in the p-ARDS group. Higher driving pressures correlated with CT and PFT abnormalities.
Conclusions:
- Pediatric ARDS survivors requiring mechanical ventilation frequently exhibit respiratory symptoms and significant pulmonary abnormalities one year post-PICUD.
- These findings underscore the necessity of systematic pulmonary evaluations for children recovering from ARDS.
Background:
Long-term pulmonary sequelae, including 1-year thoracic computed tomography (CT) sequelae of paediatric acute respiratory distress syndrome (ARDS) remain unknown. The purpose of the study was to determine pulmonary abnormalities in child survivors of pulmonary (p-ARDS) and extra-pulmonary ARDS (ep-ARDS) 1 year after paediatric intensive care unit discharge (PICUD).
Methods:
Prospective multicentre study in four paediatric academic centres between 2005 and 2014. Patients with ARDS were assessed 1 year after PICUD with respiratory symptom questionnaire, thoracic CT and pulmonary function tests (PFT).
Results:
39 patients (31 p-ARDS) aged 1.1-16.2 years were assessed. Respiratory symptoms at rest or exercise and/or respiratory maintenance treatment were reported in 23 (74%) of children with p-ARDS but in 1 (13%) of those with ep-ARDS. Thoracic CT abnormalities were observed in 18 (60%) of children with p-ARDS and 4 (50%) of those with ep-ARDS. Diffuse and more important CT abnormalities, such as ground glass opacities or mosaic perfusion patterns, were observed in 5 (13%) of children, all with p-ARDS. PFT abnormalities were observed in 30 (86%) of patients: lung hyperinflation and/or obstructive pattern in 12 (34%) children, restrictive abnormalities in 6 (50%), mild decrease in diffusing capacity in 2 (38%) and 6-min walking distance decrease in 11 (73%). Important PFT abnormalities were observed in 7 (20%) children, all with p-ARDS. Increasing driving pressure (max plateau pressure-max positive end-expiratory pressure) was correlated with increasing CT-scan abnormalities and increasing functional residual capacity (more hyperinflation) (p < 0.005).
Conclusions:
Children surviving ARDS requiring mechanical ventilation present frequent respiratory symptoms, significant CT-scan and PFT abnormalities 1 year after PICUD. This highlights the need for a systematic pulmonary assessment of these children. Trial registration The study was registered on Clinical Trials.gov PRS (ID NCT01435889).
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