Acute respiratory distress syndrome (ARDS) is a syndrome of noncardiogenic pulmonary edema and hypoxia that accompanies up to 30% of deaths in pediatric intensive care units. Pediatric ARDS (PARDS) is diagnosed by the presence of hypoxia, defined by oxygenation index or Pa o 2 /Fi o 2 ratio cutoffs, and new chest infiltrate occurring within 7 days of a known insult. Hallmarks of ARDS include hypoxemia and decreased lung compliance, increased work of breathing, and impaired gas exchange. Mortality is often accompanied by multiple organ failure. Although many modalities to treat PARDS have been investigated, supportive therapies and lung protective ventilator support remain the mainstay.
Key points
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Acute respiratory distress syndrome (ARDS) is a clinical syndrome of noncardiogenic pulmonary edema characterized by hypoxemia, radiographic infiltrates, decreased functional residual capacity, and decreased lung compliance.
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The hallmark of pathophysiology in ARDS is the loss of the alveolar epithelial-endothelial barrier function in the setting of dysregulated inflammation and coagulation pathways complicated by concurrent loss of surfactant and impairment of lymphatic drainage.
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The mainstay of management is supportive, including lung-protective mechanical ventilation, careful attention to fluid management, treatment of underlying condition, including use of appropriate antibiotics, and general supportive care. Although several therapeutic strategies have been tested in ARDS, use of lung protective ventilation is the only universally accepted strategy to decrease mortality. Use of neuromuscular blockade and prone positioning has been shown to lead to decreased mortality among adults with severe ARDS.
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