Pediatric pulmonology. Supplement
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Pediatr Pulmonol Suppl · Jan 1995
Mechanical ventilation of children with the adult respiratory distress syndrome.
Approximately 2-5% of admissions to pediatric intensive care units are due to diseases which develop into the adult respiratory distress syndrome (ARDS). About 8% of intensive care patient days are involved in treating patients with ARDS. ARDS is associated with approximately a third of deaths in the pediatric intensive care unit. ⋯ Frustratingly, little improvement in outcome has occurred over the past decade. The outcome predictors which have been developed to date have been unreliable for individual patients who may have been treated with alternative respiratory support modalities. The following is a review of current ventilatory management of ARDS, including the promising new modality of high-frequency oscillatory ventilation.
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Despite advances in ventilator management and use of extracorporeal lung support, mortality related to ARDS in pediatric patients has not been reduced over the past 20 years. Progressive respiratory failure, due to evolution of the primary illness or to complications of ventilator therapy, significantly contributes to poor outcome. ARDS is characterized by severe ventilation-perfusion mismatch and by pulmonary hypertension. ⋯ However, the results obtained in adults and newborns suggest that inhaled NO may be a useful adjuvant therapy of ARDS in children, possibly in association with other therapies. Even in adults it remains unclear whether therapy with inhaled NO can reduce morbidity and mortality. Prospectives and randomized studies are essential to assess the real utility of inhaled NO in ARDS.(ABSTRACT TRUNCATED AT 250 WORDS)