Long-term sequelae in children surviving adult respiratory distress syndrome

Fanconi, Sergio; Kraemer, Richard; Weber, Jann W.; Tschaeppler, Heinz; Pfenninger, J.

doi:10.1016/s0022-3476(85)80290-0

Cited by 62 publications

(29 citation statements)

References 18 publications

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“…Although this adds complexity and significant cost to a study because of the need for long-term follow-up, it is imperative that we not only determine whether our therapies allow a child to be liberated from the mechanical ventilator a day or two earlier than anticipated but also assess whether a child returns to his or her pre-ICU cognitive and pulmonary function in a reasonably timely fashion. Followup studies have demonstrated diminished functional outcome and quality of life after PICU admission (76), and several studies have demonstrated persistent impairments in pulmonary function of unknown long-term significance for children who required mechanical ventilation in PICUs for respiratory failure (77)(78)(79)(80)(81).…”

Section: Alternative Outcome Measuresmentioning

confidence: 99%

The Design of Future Pediatric Mechanical Ventilation Trials for Acute Lung Injury

Khemani

Newth

2010

Am J Respir Crit Care Med

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Pediatric practitioners face unique challenges when attempting to translate or adapt adult-derived evidence regarding ventilation practices for acute lung injury or acute respiratory distress syndrome into pediatric practice. Fortunately or unfortunately, there appears to be selective adoption of adult practices for pediatric mechanical ventilation, many of which pose considerable challenges or uncertainty when translated to pediatrics. These differences, combined with heterogeneous management strategies within pediatric critical care, can complicate clinical practice and make designing robust clinical trials in pediatric acute respiratory failure particularly difficult. These issues surround the lack of explicit ventilator protocols in pediatrics, either computer or paper based; differences in modes of conventional ventilation and perceived marked differences in the approach to high-frequency oscillatory ventilation; challenges with patient recruitment; the shortcomings of the definition of acute lung injury and acute respiratory distress syndrome; the more reliable yet still somewhat unpredictable relationship between lung injury severity and outcome; and the reliance on potentially biased surrogate outcome measures, such as ventilator-free days, for all pediatric trials. The purpose of this review is to highlight these challenges, discuss pertinent work that has begun to address them, and propose potential solutions or future investigations that may help facilitate comprehensive trials on pediatric mechanical ventilation and define clinical practice standards.

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Section: Alternative Outcome Measuresmentioning

confidence: 99%

The Design of Future Pediatric Mechanical Ventilation Trials for Acute Lung Injury

Khemani

Newth

2010

Am J Respir Crit Care Med

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“…This infant had nearly normal Rrs and still considerably reduced Crs 2.5 months after ARDS. Fanconi et al have shown in 9 children surviving severe ARDS that all had long-standing abnormal lung function [11].…”

Section: Casementioning

confidence: 99%

Respiratory syncytial virus triggered adult respiratory distress syndrome in infants: A report of two cases

Bachmann

Pfenninger

1994

Intensive Care Med

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Two infants with severe respiratory syncytial virus infection which resulted eventually in classical adult respiratory distress syndrome (ARDS) are presented. Both infants had severe apneic spells, necessitating intubation and mechanical ventilation (MV). Chest radiographs changed after a few days after institution of MV from initial bronchopneumonia like pattern to severe ARDS. Assessment of respiratory system mechanics (single breath occlusion technique) revealed severe restrictive disease in both cases. The first patient recovered with residual restrictive changes determined during a follow-up 2.5 months later, whereas the second infant died because of ARDS, pulmonary interstitial emphysema and hypoxemic hypoxia.

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“…The M B N W and F R C determinations were assessed on the sub ject seated with the noseclip in place as described previously [1][2][3]. The total expired nitrogen was determined by integrating the prod uct o f the instantaneous viscosity-corrected expiratory flow rates and the instantaneous F N 2.…”

Section: Pulmonary Function Testsmentioning

confidence: 99%

“…We have adapted the technique o f multibreath ni trogen washout (M BNW ) so as to be able to apply it in children (especially in patients with C F already suffering from hypoxemia [1][2][3]) for the evaluation of intrapulmonary gas distribution and mixing using the moment ratio analysis to the whole washout curve [4][5][6], In addition, as a new approach with the mea surement o f M B N W , blood gases have been deter mined at room air (F i0 2 = 0.21) and at the end o f the M B N W after 100% oxygen breathing (F i0 2 = 1.0) with a final intraalveolar nitrogen fraction (F N 2) of 0.02.…”

Section: Introductionmentioning

confidence: 99%

Ventilatory Inequalities, Pulmonary Function and Blood Oxygenation in Advanced States of Cystic Fibrosis

Kraemer

Schöni²

1990

Respiration

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In 36 patients with cystic fibrosis (CF), aged 6.2–26.4 years, the relationship between functional lung deterioration and gas exchange characteristics was studied by backward stepwise discriminant analysis of 22 dependent variables, within 3 clinically defined severity degrees of the disease. The stratification was based on a general clinical score, a chest X-ray score and the relative underweight of the patients. Lung function testing included whole body plethysmography and multibreath nitrogen washouts (MBNW). Blood gas analyses were performed under room air (FiO₂ = 0.21) and 100% oxygen breathing (FiO₂ = 1.0). The clinical score correlated best with vital capacity (r = 0.776) and PaO₂ at room air (r = 0.829); the X-ray score correlated best with PaO₂ at room air (r = 0.768). Impairment of oxygenation characteristics was closely related to the degree of ventilation inequalities (MBNW) and the amount of trapped gases, both increasingly present from severity group I to III. In addition the calculated arterial-alveolar oxygen ratio (group I 0,47; group II 0,38; group III 0.29) as an estimate of intrapulmonary gas exchange deficiency revealed that only patients with mild lung involvement (group I) fulfil the functional conditions to achieve a paO₂ of 70 mm Hg at room air, whereas patients with severer lung involvement (groups II and III) would need a FiO₂ of 26.0 or 39.6, respectively, in order to have a sufficient oxygenation

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Long-term sequelae in children surviving adult respiratory distress syndrome

Cited by 62 publications

References 18 publications

The Design of Future Pediatric Mechanical Ventilation Trials for Acute Lung Injury

The Design of Future Pediatric Mechanical Ventilation Trials for Acute Lung Injury

Respiratory syncytial virus triggered adult respiratory distress syndrome in infants: A report of two cases

Ventilatory Inequalities, Pulmonary Function and Blood Oxygenation in Advanced States of Cystic Fibrosis

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