Mechanisms of Acute Respiratory Distress Syndrome in Children and Adults

Abstract

There are significant obstacles to performing research on children with acute respiratory distress syndrome. However, epidemiologic, clinical, and animal studies suggest age-dependent differences in the pathophysiology of acute respiratory distress syndrome. In order to reduce the prevalence and improve the outcome of patients with acute respiratory distress syndrome, translational studies of inflammatory, apoptotic, alveolar fluid clearance, and repair mechanisms are needed. Understanding the differences in pathophysiologic mechanisms in acute respiratory distress syndrome between children and adults should facilitate identification of novel therapeutic interventions to prevent or modulate lung injury and improve lung repair.

Multicenter Randomized Controlled Trial of Inhaled Nitric Oxide for Pediatric Acute Respiratory Distress Syndrome

“…The host, etiologies, and pathophysiologic response to acute lung injury differ considerably between children and adults. 12,13 The most common precipitating cause for ARDS in adults is sepsis, but in children it is pneumonia, and there are likely differences in the organisms responsible for these diseases. 14,15 Additionally, there are clearly differences in comorbidities between children and adults.…”

“…The response to injury differs considerably not only between adults and children but also between neonates and infants and older children. 12 In preterm and term neonates with respiratory failure, iNO has been shown to significantly decrease the incidence of bronchopulmonary dysplasia and increase survival in premature infants with the respiratory distress syndrome, as well as decrease the need for ECMO in term and near term neonates with hypoxic respiratory failure. [16][17][18] The mechanisms responsible for the improved outcomes in those receiving iNO are unknown but do not appear to be caused by a sustained improvement in oxygenation.…”

Regulation of inflammatory biomarkers by intravenous methylprednisolone in pediatric ARDS patients: Results from a double-blind, placebo-controlled randomized pilot trial

“…Importantly, both serum and BAL cytokine levels correlate with increased mortality rates[15]. The large majority of these findings were obtained in adult studies and our knowledge about changes in inflammatory markers in pediatric ARDS patients is very limited[16]. As the pulmonary and immune systems of children are still in development, differences in their immune and inflammatory responses compared to adults are to be expected.…”

Clinical Study of High Frequency Oscillatory Ventilation on Neonatal Respiratory Distress Syndrome

“…Alveolar surfactant is to improve lung compliance and aerobic conditions and thus reduce the oxygen concentration, with lubrication and anti-atrophy [4] . Clinically, the use of synchronized intermittent mandatory ventilation in the treatment of neonatal respiratory distress syndrome, due to its low oxygen concentration and pressure, the ideal ventilation and oxygenation effect, if the high pressure, high ventilation and high suction oxygen in the case, can easily lead to lung poisoning and lung injury, which in turn lead to pneumothorax, chronic lung disease and other complications of premature children [5] . High-frequency oscillatory ventilation has become a new mode of ventilation, with low tidal volume, high ventilation frequency, low ventilation pressure and a little help to correct carbon dioxide retention and hypoxemia, and further improve the oxygenation and oxygen concentration, thereby reducing the body's high oxygen injury, significantly reduce the inhibition of endogenous alveolar surfactant synthesis [6] .…”