Pediatric acute lung injury.
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.
Dahlem
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Medical Center of Coburg, Children's Hospital, Ketschendorferstr. 33, 96450 Coburg, Bayern, Germany. PDahlem@hotmail.com
van Aalderen
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WM
Bos
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AP
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007223:Infant; D008170:Lung Compliance; D009569:Nitric Oxide / Q000008:administration & dosage; D011110:Polymorphism, Genetic; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D014692:Ventilation-Perfusion Ratio
D005938:Glucocorticoids; D011663:Pulmonary Surfactants; D009569:Nitric Oxide