Author(s): Dahlem P, van Aalderen WM, Bos AP
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Abstract Among ventilated children, the incidence of acute lung injury (ALI) was 9\%; of that latter group 80\% developed the acute respiratory distress syndrome (ARDS). The population-based prevalence of pediatric ARDS was 5.5 cases/100.000 inhabitants. Underlying diseases in children were septic shock (34\%), respiratory syncytial virus infections (16\%), bacterial pneumonia (15\%), near-drowning 9\%, and others. Mortality ranged from 18\% to 27\% for ALI (including ALI-non ARDS and ARDS) and from 29\% to 50\% for ARDS. Mortality was only 3\%-11\% in children with ALI-non ARDS. As risk factors, oxygenation indices and multi-organ failure have been identified. New insights into the pathophysiology (for example the interplay between intraalveolar coagulation/fibrinolysis and inflammation and the genetic polymorphism for the angiotensin-converting enzyme) offer new therapeutic options. Lung protective mechanical ventilation with optimal lung recruitment is the mainstay of supportive therapy. New therapeutic modalities refer to corticosteroid and surfactant treatment. Well-designed follow up studies are needed.
This article was published in Paediatr Respir Rev
and referenced in Journal of Pulmonary & Respiratory Medicine