Introduction. We analyzed a database of 320 pediatric patients with acute lung injury (ALI), to test the hypothesis that positive fluid balance is associated with worse clinical outcomes in children with ALI. Methods. This is a post-hoc analysis of previously collected data. Cumulative fluid balance was analyzed in ml per kilogram per day for the first 72 hours after ALI while in the PICU. The primary outcome was mortality; the secondary outcome was ventilator-free days. Results. Positive fluid balance (in increments of 10 mL/kg/24 h) was associated with a significant increase in both mortality and prolonged duration of mechanical ventilation, independent of the presence of multiple organ system failure and the extent of oxygenation defect. These relationships remained unchanged when the subgroup of patients with septic shock (n = 39) were excluded. Conclusions. Persistently positive fluid balance may be deleterious to pediatric patients with ALI. A confirmatory, prospective randomized controlled trial of fluid management in pediatric patients with ALI is warranted.

An optimized mNGS assay for pulmonary microbes demonstrates significant inoculation of the lower airways of immunocompromised children with diverse bacteria, fungi, and viruses. Potential pathogens can be identified based on absolute and relative abundance. Ongoing investigation is needed to determine the pathogenic significance of outlier microbes in the lungs of immunocompromised children with pulmonary disease.

Higher levels of plasma RAGE measured shortly after reperfusion predicted poor short-term outcomes from lung transplantation. Elevated plasma RAGE levels may have both pathogenetic and prognostic value in patients after lung transplantation.

Objective Determine the feasibility of pulmonary function (PFT) and quality of life (QOL) evaluations in children after Acute Respiratory Distress Syndrome (ARDS). Design A prospective follow-up feasibility study Setting A tertiary pediatric intensive care unit Patients Children <18 year old with ARDS admitted between 2000 and 2005. Measurements and Main Results PFTs and QOL questionnaires performed approximately 12-months post-illness were analyzed and correlated to in-hospital clinical parameters. QOL data was compared to published pediatric chronic asthma and general pediatric norms. 180 patients met ARDS criteria; 37 (20%) died, 90 (51%) declined participation, 28 (16%) consented but did not return, and 24 (13%) returned for follow up visit. Twenty-three patients completed QOL testing and 17 completed PFTs. Clinical characteristics of those who returned were no different from those who did not except for age (median age 4.9 vs. 1.8 years). One third had mild to moderate pulmonary function deficits. QOL scores were marginal with general health perception, physical functioning, and behavior being areas of concern. These scores were lower than scores in children with chronic asthma. Parental QOL assessments report lower scores in single parent homes but no differences were noted by race or parental employment status. Conclusion Valuable information may be discerned from ARDS patients who return for follow-up evaluation. In this pilot study up to one-third of children with ARDS exhibit pulmonary function deficits and 12-month post-illness QOL scores are lower than in children with chronic asthma. Parental perceptions of post-illness QOL may be negatively impacted by socioeconomic constraints. Long term follow of children with ARDS is feasible and bears further investigation.