Adult respiratory distress syndrome in children

Twenty patients (age 2 weeks to 15 years) who fulfilled strict selection criteria for adult respiratory distress syndrome were identified during a 3 1/2-year period. The underlying disease was intra-abdominal infection/septicemia in seven, hypovolemic shock, near drowning, closed space burn, or cardiogenic shock caused by nupercaine intoxication in two each, and miscellaneous in five. The mean time of artificial ventilation with PEEP was 18 days (range 5 to 92), and the mean time of FIO2 greater than or equal to 0.5 while on the ventilatory 139 hours (range 12 to 648). PEEP levels were most often between 8 and 15 cm H2O. Eight patients had a pulmonary air leak. Eight patients died (40% mortality). Death was nearly always related to unresolved basic medical or surgical problems and multiple organ failure. Treatment of ARDS includes elimination of the cause of ARDS, early institution of mechanical ventilation with PEEP, prompt recognition and treatment of superimposed infections, and careful management of additional organ failures.