Pediatric acute respiratory distress syndrome - current views (Review)

Liu, Jinfeng; Wang, Wei; Liu, Fengli; Li, Zhenguang

doi:10.3892/etm.2017.5628

Cited by 2 publications

(2 citation statements)

References 84 publications

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“…Acute respiratory distress syndrome (ARDS) is a constellation of clinical features characterized by hypoxemia, dyspnea, and a marked increase in the work of breathing. 1 Children have varying incidence of ALI/ARDS ranging from 2.2 to 16 per 100,000 pediatric population. 2 Pediatric acute respiratory distress syndrome (PARDS) is a challenging problem with high morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Early Neuromuscular Blockade in Children with Pediatric Acute Respiratory Distress Syndrome

Chandra

Goel

Dawra

2020

J Pediatr Intensive Care

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Pediatric acute respiratory distress syndrome (PARDS) is a challenging problem with high mortality. Role of neuromuscular blockade in the management of ARDS to date has been controversial, and this study was done to study the role of neuromuscular blockade in children having PARDS and development of associated complications, if any. This was a prospective, case–control study conducted in the pediatric intensive care unit (PICU) of a tertiary care teaching hospital, over a period of 24 months. Patients of age 1 to 18 years who presented with or developed PARDS during their course of hospitalization were included after written informed consent was obtained from their parents and/or guardians. Patients with PARDS requiring invasive mechanical ventilation were partitioned into a case group and a control group. Case group patients were sedated and paralyzed using midazolam (1 µg/kg/min) and vecuronium (1 µg/kg/min), respectively, along with institution of definitive management. Control group patients were given definitive and supportive therapy, but no neuromuscular blocking agents (NMBAs). All patients were followed up for signs and symptoms of myopathy or neuropathy during the entire duration of hospital stay and up to 3 months after discharge. During the study period, 613 patients were admitted to the PICU of which 91 patients qualified as having PARDS. Sepsis was the main etiology in 67 of the 91 patients (73.6%) with PARDS. Fifty-nine patients were included in the study, of which 29 patients were included in the case group and 30 patients were included in the control group. Among the 29 case group patients, 25 patients (86.2%) were successfully extubated. Four patients from the case group expired, while 14 out of 30 control group patients (46.7%) expired. Hypotension was present in 26 case group patients (89.6%), of which all showed resolution within 48 hours of definitive treatment. The mean time to resolution of hypotension was 41.6 hours (standard deviation [SD]: 5.759; range: 24–48) for case group patients, significantly lower (p < 0.0001) than the mean time to resolution of 103 hours (SD: 18.995; range: 90–126) for the 10 control group patients with hypotension that survived. Mean oxygenation index (OI) following 48 hours of vecuronium therapy was significantly lower (p < 0.0001; 95% confidence interval: 5.9129–9.9671) than mean OI at admission for case group patients. None of the patients receiving vecuronium exhibited neuromuscular deficit during their hospital stay, at time of discharge, or at follow-up evaluation up to 3 months after discharge. In this study, pediatric cases diagnosed with PARDS and managed with mechanical ventilation and vecuronium therapy had improved mean OI following 48 hours of NMBA therapy and a lower mortality when compared with matched control group patients. Incidence of NMBA-related weakness was not commonly observed in these patients.

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Section: Introductionmentioning

confidence: 99%

Early Neuromuscular Blockade in Children with Pediatric Acute Respiratory Distress Syndrome

Chandra

Goel

Dawra

2020

J Pediatr Intensive Care

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“…With the continuous improvements in life support technology, the mortality rate of children with ARDS has decreased, but still ranges between 33.7%-61.0% [1,2]. Mechanical ventilation remains the preferred treatment modality for ARDS [3]. As is the case for adults, in pediatric ARDS, it is recommended to employ a lung-protective ventilation strategy [4][5], including small tidal volume, appropriate platform pressure, and optimal positive end-expiratory pressure (PEEP).…”

Section: Introductionmentioning

confidence: 99%

Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children

Xie¹

2018

AJP

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To investigate the impact of the optimal respiratory system dynamic compliance (Cdyn) strategy for titrating positive end-expiratory pressure (PEEP) on the prognosis of acute respiratory distress syndrome (ARDS) in children. A total of 30 patients with ARDS admitted in the pediatric intensive care unit (PICU) of Guangxi Maternity and Child Health Hospital were randomly divided into two groups (n=15). PEEP was set in the control group according to the PEEP/ fraction of inspired oxygen (FiO 2 ) in American ARDS collaboration network while the optimal Cdyn strategy was employed for the treatment group. We used the pressure control ventilation (PCV) mode and small tidal volume (7mL/Kg). Respiratory mechanics, hemodynamics, and inflammatory cytokines were monitored in each group before and after the experiment. The time of mechanical ventilation, hospital stay in the PICU, and 28-day mortality were compared. There were no significant differences in terms of sex, age, and severity of disease between the two groups. The optimal PEEP of the control group was significant lower than that of the treatment group [(6.4±1.4) cmH 2 O vs. (9.9±1.6) cmH 2 O, P<0.01]. Cdyn and oxygenation index (OI) in the two groups were improved, and the degree of improvement in the treatment group was significantly higher than that in the control group [Cdyn after the experiment at 2 h: (0.39±0.03) mL/(cmH 2 O.kg) vs (0.36±0.03) mL/(cmH 2 O.kg), P<0.05; 24h: (0.40±0.03) mL/(cmH 2 O.kg) vs (0.38±0.03) mL/(cmH 2 O.kg), P<0.05; 48 h: (0.43±0.02) mL/(cmH 2 O.kg) vs. (0.40±0.02) mL/(cmH 2 O.kg), P<0.01; OI after the experiment at 24 h: (20.07±2.12) cmH 2 O/mmHg vs (21.94±2.05) cmH 2 O/mmHg, P<0.05; 48 h: (17.51±1.64) cmH 2 O/mmHg vs (19.82±2.07) cmH 2 O/mmHg, P<0.01]. There were no significant differences in heart rate, mean arterial pressure, and cardiac index before and after the experiment (all P>0.05). Interleukin-6 (IL-6) in two groups gradually decreased, and the decrease was greater in the treatment group than in the control group [IL-6 after the experiment at 24 h: (84.58±9.11) ng/L vs (93.18±9.27) ng/L, P<0.05; 48 h: (76.67±9.23) ng/L vs (90.10±9.42) ng/L, P<0.01]. The length of mechanical ventilation and hospital stay in the PICU was significantly shorter in the treatment than in the control group [length of mechanical ventilation: (6.62±1.26) days vs (8.06±1.44) days; hospital stay in the PICU: (8.12±1.31) days vs (9.53±1.42) days, all P<0.05). There was no barotrauma and no difference in mortality between the two groups (P>0.05). The optimal Cdyn method for titrating PEEP improved respiratory mechanics in ARDS, shortened the time of mechanical ventilation, and had no serious adverse effect on hemodynamics.

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Pediatric acute respiratory distress syndrome - current views (Review)

Cited by 2 publications

References 84 publications

Early Neuromuscular Blockade in Children with Pediatric Acute Respiratory Distress Syndrome

Early Neuromuscular Blockade in Children with Pediatric Acute Respiratory Distress Syndrome

Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children

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