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Adult respiratory distress syndrome in children
Insights
Pediatric acute respiratory distress syndrome (ARDS) is severe, often leading to complications like air leaks and death. Survivors may experience long-term lung function changes and imaging abnormalities.
Area of Science:
- Pediatric critical care medicine
- Pulmonology
- Pathology
Background:
- Adult respiratory distress syndrome (ARDS) is a severe lung condition.
- Pediatric ARDS presents unique challenges in diagnosis and management.
- Understanding long-term outcomes is crucial for affected children.
Purpose of the Study:
- To review clinical, radiological, and pathological data of pediatric ARDS patients.
- To describe the course, complications, and outcomes of ARDS in children.
- To investigate potential links between ARDS, oxygen toxicity, and long-term lung changes.
Main Methods:
- Retrospective review of clinical, radiological, and pathological data for nine pediatric ARDS patients.
- Analysis of underlying conditions, precipitating events, ventilation requirements, and oxygen exposure.
- Evaluation of autopsy findings and follow-up pulmonary function tests and chest radiographs in survivors.
Main Results:
- Nine children (7 months to 15 years) with ARDS were studied, with diverse underlying causes.
- All patients required prolonged mechanical ventilation and high inspired oxygen levels.
- Eight patients experienced air leak complications; five patients died. Autopsies revealed alveolar duct fibrosis.
- Survivors showed mild restrictive lung changes and persistent radiographic densities.
Conclusions:
- Pediatric ARDS is associated with significant morbidity, including air leaks and mortality.
- Alveolar duct fibrosis, potentially linked to oxygen toxicity, was observed in fatal cases.
- Survivors of pediatric ARDS may experience persistent pulmonary function deficits and radiographic abnormalities.
Abstract:
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.