Acute respiratory distress syndrome in children: a 10 year experience

Background: Acute respiratory distress syndrome is a well-recognized condit ion resulting in high permeability pulmonary edema associated with a high m orbidity. Objectives: To examine a 10 year experience of pre disposing factors, descr ibe the clinical course, and assess predictors of mortality in children wit h this syndrome. Methods: The medical records of all admissions to the pediatric intensive c are unit over a 10 year period were evaluated to identify children with ARD S'. Patients were considered to have ARDS if they met all of the following criteria: acute onset of diffuse bilateral pulmonary infiltrates of non-car diac origin and severe hypoxemia defined by <200 partial pressure of oxygen during greater than or equal to 6 cm H2O positive end-expiratory pressure for a minimum of 24 hours. The medical records were reviewed for demographi c, clinical, and physiologic information including PaO22/forced expiratory O-2, alveolar-arterial O-2 difference, and ventilation index. Results: We identified 39 children with the adult respiratory distress synd rome. Mean age was 7.4 years (range 50 days to 16 years) and the male:femal e ratio was 24:15. Predisposing insults included sepsis, pneumonias, malign ancy, major trauma, shock, aspiration, near drowning, burns, and envenomati on. The mortality rate was 61.5%. Predictors of death included the PaO2/FIO 2, ventilation index and A-aDO(2)(3) on the second day after diagnosis. Non survivors had significantly lower PaO2/FIO2 (116+/-12 vs. 175+/-8.3, P<0.00 1), and higher A-aDO(2) (368+/-28.9 vs. 228.0+/-15.5, P<0.001) and ventilat ion index (43.3+/-2.9 vs. 53.1+/-18.0, P<0.001) than survivors. Conclusions: Local mortality outcome for ARDS is comparable to those in ter tiary referral institutions in the United States and Western Europe. The Pa O2/FIO2, A-aDO(2) and ventilation index are valuable for predicting outcome in ARDS by the second day of conventional therapy. The development of a lo cal risk profile may allow early application of innovative therapies in thi s population.