Clinical Analysis Of Acute Respiratory Distress Syndrome In Children

Objective:The aim of this study is to evaluate the diagnosis and treatment, underlying cause and prognosis associated factors of acute respiratory distress syndrome (ARDS) in children, and provide a theoretical reference to identify early and how to give a reasonable treatment for this disease.Method:A retrospective analysis was conducted for cases diagnosed with acute respiratory distress syndrome (except neonates) admitted to PICU, the First Affiliated Hospital of Guangxi Medical University from January,2010to Decdmeber,2012. All cases were divided into sepsis group and non-sepsis group according to the sepsis diagnosis criteria.Results:1.Total34cases were recruited in this study accounting for hospitalized children constitute of2%.Among all,20cases died (including7withdraw case who died after discharged),with a mortality of58.8%.30cases(88.2%) were derived from medical disease, while4(11.7%)from surgical disease.28cases (93.3%) received mechanical ventilation, among which,23cases (76%) received mechanical ventilation for more than72hours.2.12cases(35.2%) were diagnosed with pneumonia (without sepsis), which was the most common primary disease, while11cases (32.3%) were pneumonia (with sepsis), the second most common primary disease.3. For all cases, blood gas analysis was conducted8hours before ventilation and24hours,48hours,72hours after ventilation initiation, respectively. In non-sepsis group, PaCO2and PaO2improved significantly after ventilation treatment. In sepsis group, not only PaCO2and PaO2but also PH and PaO2/FiO2improved significantly.4. The average time between onset of primary disease and ARDS diagnosis was (70.6±44.3) hours with a median of72hours. Compared with non-sepsis group, the time between onset of primary disease and ARDS diagnosis was shorter in sepsis group (t=2.137,P=0.046)5. Mean tidal volume in all cases was (5.7±3.5) ml/kg, which consist with the requirement protective ventilation. There was no significant difference of ventilation parameter setting between sepsis group and non-sepsis group. Only one case had air leak with subcutaneous emphysema and pneumomediastinum. The incidence of ventilator-associated lung injury was2.9%.6. The most important high risk factor associated to ARDS in children was pneumonia. Both single factor analysis and the multiple factors LOGISTIC models showed that the pattern of disease derivation, primary disease, pneumonia were significantly related to ARDS prognosis.Conclusion:1. ARDS in children is still a sever disease with a high mortality.2. Pneumonia is the most important underlying cause of ARDS in children.3. Protective ventilation is an important strategy for ARDS treatment.