Assuntos
Asfixia Neonatal/sangue , Lactatos/sangue , Humanos , Recém-Nascido , Ácido Láctico , Valor Preditivo dos Testes , PrognósticoRESUMO
Nine children surviving severe adult respiratory distress syndrome were studied 0.9 to 4.2 years after the acute illness. They had received artificial ventilation for a mean of 9.4 days, with an Fio2 greater than 0.5 during a mean time of 34 hours and maximal positive end expiratory pressure levels in the range of 8 to 20 cm H2O. Three children had recurrent respiratory symptoms (moderate exertional dyspnea and cough), and two had evidence of fibrosis on chest radiographs. All patients had abnormal lung function; the most prominent findings were ventilation inequalities, as judged by real-time moment ratio analysis of multibreath nitrogen washout curves (abnormal in eight of nine patients) and hypoxemia (seven of nine). Lung volumes were less abnormal; one patient had restrictive and two had obstructive disease. A significant correlation between intensive care measures (Fio2 greater than 0.5 in hours and peak inspiratory plateau pressure) and lung function abnormalities (moment ratio analysis and hypoxemia) was found. A possibly increased susceptibility of the pediatric age group to the primary insult or respiratory therapy of adult respiratory distress syndrome is suggested.
Assuntos
Síndrome do Desconforto Respiratório/fisiopatologia , Adolescente , Criança , Pré-Escolar , Ecocardiografia , Eletrocardiografia , Emergências , Seguimentos , Coração/fisiopatologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Medidas de Volume Pulmonar , Exame Físico , Respiração com Pressão Positiva , Radiografia , Respiração Artificial , Testes de Função RespiratóriaRESUMO
Twenty patients (age 2 weeks to 15 years) who fulfilled strict selection criteria for adult respiratory distress syndrome were identified during a 3 1/2-year period. The underlying disease was intra-abdominal infection/septicemia in seven, hypovolemic shock, near drowning, closed space burn, or cardiogenic shock caused by nupercaine intoxication in two each, and miscellaneous in five. The mean time of artificial ventilation with PEEP was 18 days (range 5 to 92), and the mean time of FIO2 greater than or equal to 0.5 while on the ventilatory 139 hours (range 12 to 648). PEEP levels were most often between 8 and 15 cm H2O. Eight patients had a pulmonary air leak. Eight patients died (40% mortality). Death was nearly always related to unresolved basic medical or surgical problems and multiple organ failure. Treatment of ARDS includes elimination of the cause of ARDS, early institution of mechanical ventilation with PEEP, prompt recognition and treatment of superimposed infections, and careful management of additional organ failures.