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Long-term sequelae in children surviving adult respiratory distress syndrome
Insights
Children surviving severe adult respiratory distress syndrome often experience lasting lung function abnormalities, including ventilation inequalities and hypoxemia, suggesting increased pediatric susceptibility to critical respiratory illness and its treatments.
Area of Science:
- Pediatric Critical Care Medicine
- Pulmonology
- Respiratory Medicine
Background:
- Severe adult respiratory distress syndrome (ARDS) can have long-term consequences.
- Pediatric survivors of ARDS require further investigation regarding persistent respiratory sequelae.
Purpose of the Study:
- To assess the long-term lung function and respiratory health in children who survived severe ARDS.
- To identify correlations between intensive care interventions and pulmonary sequelae in pediatric ARDS survivors.
Main Methods:
- Longitudinal study of nine pediatric ARDS survivors (0.9–4.2 years post-illness).
- Evaluation included pulmonary function tests (multibreath nitrogen washout), chest radiography, and assessment of respiratory symptoms.
- Analysis of correlations between intensive care parameters (FiO2, PEEP, peak inspiratory pressure) and lung function outcomes.
Main Results:
- Eight of nine patients exhibited ventilation inequalities (abnormal moment ratio analysis).
- Seven of nine patients presented with hypoxemia.
- Three children reported recurrent respiratory symptoms; two showed radiographic evidence of fibrosis.
- Significant correlations were found between intensive care measures and lung function abnormalities.
Conclusions:
- Pediatric survivors of severe ARDS demonstrate significant long-term lung function abnormalities, particularly ventilation inequalities and hypoxemia.
- The findings suggest a potential increased susceptibility of the pediatric population to the primary insult of ARDS or its associated respiratory therapies.
Abstract:
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.