Document Detail

Assessment of pulmonary function in the early phase of ARDS in pediatric patients.
MedLine Citation:
PMID:  9094724     Owner:  NLM     Status:  MEDLINE    
Scant data are available on lung function in acute respiratory distress syndrome (ARDS) in pediatric patients. We measured respiratory mechanics by single-breath occlusion and maximum expiratory flow-volume curves by forced deflation in ten critically ill infants with clinical ARDS. Ten mechanically ventilated infants without lung disease served as the control group. To assess the severity of the lung injury in the infants with ARDS, we modified an adult scoring system that calculates a score (from 0 to 4; > 2.5 indicates severe lung injury) based on the extent of chest radiographic changes, degree of hypoxemia, amount of positive end-expiratory pressure (PEEP), and total respiratory system compliance. The lung injury scores of our patients were in the range of 2.75 to 3.75. The lung injury scores of the control group were zero. The predominant alteration in lung function was restrictive, as characterized by a significant decrease in total respiratory system compliance (0.41 +/- 0.13 ml/cmH2O/kg versus 1.12 +/- 0.16 ml/cmH2O/kg of controls; P < 0.001) and forced vital capacity (21.5 +/- 6.5 ml/kg versus 59.2 +/- 6.3 ml/kg of controls; P < 0.001). Maximum expiratory flow rates at 10% forced vital capacity were significantly increased (23.6 +/- 20.1 ml/kg/sec versus 8.4 +/- 2.5 ml/kg/sec of controls; P < 0.05), confirming the absence of any significant obstructive abnormalities. The passive expiratory flow-volume curves were curvilinear and convex in shape, indicating inhomogeneous lung pathology. The inhomogeneous distribution of lung injury in ARDS restricts the validity of respiratory mechanics measurements that rely on a single-compartment model. However, the forced deflation technique allows accurate spirometric assessments of the severity of restrictive (and obstructive) lung function changes in intubated infants with severe ARDS. Such measurements can be incorporated into lung injury scoring systems to classify the severity of the disease process for the purpose of outcome evaluation and to evaluate the effect of therapeutic interventions.
C J Newth; M Stretton; T W Deakers; J Hammer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatric pulmonology     Volume:  23     ISSN:  8755-6863     ISO Abbreviation:  Pediatr. Pulmonol.     Publication Date:  1997 Mar 
Date Detail:
Created Date:  1997-06-09     Completed Date:  1997-06-09     Revised Date:  2006-03-28    
Medline Journal Info:
Nlm Unique ID:  8510590     Medline TA:  Pediatr Pulmonol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  169-75     Citation Subset:  IM    
Division of Pediatric Critical Care, Children's Hospital of Los Angeles, CA 90027, USA.
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MeSH Terms
Case-Control Studies
Child, Preschool
Feasibility Studies
Lung / physiopathology
Maximal Expiratory Flow-Volume Curves / physiology
Respiration, Artificial
Respiratory Distress Syndrome, Adult / diagnosis*,  physiopathology,  therapy
Respiratory Function Tests
Respiratory Mechanics / physiology*
Severity of Illness Index

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