Definition Of Acute Respiratory Distress Syndrome Research Articles

Predictors of survival in critically ill patients with acute respiratory distress syndrome (ARDS): an observational study.

BackgroundCurrently there is no ARDS definition or classification system that allows optimal prediction of mortality in ARDS patients. This study aimed to examine the predictive values of the AECC and Berlin definitions, as well as clinical and respiratory parameters obtained at onset of ARDS and in the course of the first seven consecutive days.MethodsThe observational study was conducted at a 14-bed intensive care unit specialized on treatment of ARDS. Predictive validity of the AECC and Berlin definitions as well as PaO2/FiO2 and FiO2/PaO2*Pmean (oxygenation index) on mortality of ARDS patients was assessed and statistically compared.ResultsFour hundred forty two critically-ill patients admitted for ARDS were analysed. Multivariate Cox regression indicated that the oxygenation index was the most accurate parameter for mortality prediction. The third day after ARDS criteria were met at our hospital was found to represent the best compromise between earliness and accuracy of prognosis of mortality regarding the time of assessment. An oxygenation index of 15 or greater was associated with higher mortality, longer length of stay in ICU and hospital and longer duration of mechanical ventilation. In addition, non-survivors had a significantly longer length of stay and duration of mechanical ventilation in referring hospitals before admitted to the national reference centre than survivors.ConclusionsThe oxygenation index is suggested to be the most suitable parameter to predict mortality in ARDS, preferably assessed on day 3 after admission to a specialized centre. Patients might benefit when transferred to specialized ICU centres as soon as possible for further treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-016-0272-4) contains supplementary material, which is available to authorized users.

Progress and perspectives in definition of acute respiratory distress syndrome

Acute respiratory distress syndrome(ARDS) is a disease of acute onset characterized by hypoxemia and infiltrates on chest radiographs that affects both adults and children of all ages.This article reviewed the evolution of the definition of ARDS over nearly five decades, with a special focus on the new pediatric definition, also discuss recommendations for future definition of this syndrome. Key words: Acute respiratory distress syndrome; Diagnosis; Child

The Acute Respiratory Distress Syndrome (ARDS) in mechanically ventilated burn patients: An analysis of risk factors, clinical features, and outcomes using the Berlin ARDS definition

BackgroundThe Berlin definition of Acute Respiratory Distress Syndrome (ARDS) has been applied to military burns resulting from combat-related trauma, but has not been widely studied among civilian burns. This study's purpose was to use the Berlin definition to determine the incidence of ARDS, and its associated respiratory morbidity, and mortality among civilian burn patients. MethodsRetrospective study of burn patients mechanically ventilated for ≥48h at an American Burn Association-verified burn center. The Berlin criteria identified patients with mild, moderate, and severe ARDS. Logistic regression was used to identify variables predictive of moderate to severe ARDS, and mortality. The outcome measures of interest were duration of mechanical ventilation and in-hospital mortality. Values are shown as the median (Q1–Q3). ResultsWe included 162 subjects [24% female, age 48 (35–60), % total body surface area (TBSA) burn 28 (19–40), % body surface area (BSA) full thickness (FT) burn 13 (0–30), and 62% with inhalation injury]. The incidence of ARDS was 43%. Patients with ARDS had larger %TBSA burns [30.5 (23.1–47.0) vs. 24.8 (17.1–35), p=0.007], larger FT burns [20.5(5.4–35.5) vs. 7 (0–22.1), p=0.001], but had no significant difference in the incidence of inhalation injury (p=0.216), compared to those without ARDS. The % FT burn predicted the development of moderate to severe ARDS [OR 1.034, 95%CI (1.013–1.055), p=0.001]. ARDS developed in the 1st week after burn in 86% of cases. Worsening severity of ARDS was associated with increased days of mechanical ventilation in survivors (p=0.001), a reduction in ventilator-free days/1st 30 days in all subjects (p=0.004), and a strong indication of increased mortality (0% in mild ARDS vs. 50% in severe ARDS, unadjusted p=0.02). Neither moderate ARDS nor severe ARDS were significant predictors of death. ConclusionsARDS is common among mechanically ventilated civilian burn patients, and develops early after burn. The extent of full thickness burn predicted development of moderate to severe ARDS. Increasing severity of ARDS based upon the Berlin definition was associated with a significantly greater duration of mechanical ventilation and a trend toward higher mortality.

Acute Respiratory Distress Syndrome Measurement Error. Potential Effect on Clinical Study Results.

Identifying patients with acute respiratory distress syndrome (ARDS) is a recognized challenge. Experts often have only moderate agreement when applying the clinical definition of ARDS to patients. However, no study has fully examined the implications of low reliability measurement of ARDS on clinical studies. To investigate how the degree of variability in ARDS measurement commonly reported in clinical studies affects study power, the accuracy of treatment effect estimates, and the measured strength of risk factor associations. We examined the effect of ARDS measurement error in randomized clinical trials (RCTs) of ARDS-specific treatments and cohort studies using simulations. We varied the reliability of ARDS diagnosis, quantified as the interobserver reliability (κ-statistic) between two reviewers. In RCT simulations, patients identified as having ARDS were enrolled, and when measurement error was present, patients without ARDS could be enrolled. In cohort studies, risk factors as potential predictors were analyzed using reviewer-identified ARDS as the outcome variable. Lower reliability measurement of ARDS during patient enrollment in RCTs seriously degraded study power. Holding effect size constant, the sample size necessary to attain adequate statistical power increased by more than 50% as reliability declined, although the result was sensitive to ARDS prevalence. In a 1,400-patient clinical trial, the sample size necessary to maintain similar statistical power increased to over 1,900 when reliability declined from perfect to substantial (κ = 0.72). Lower reliability measurement diminished the apparent effectiveness of an ARDS-specific treatment from a 15.2% (95% confidence interval, 9.4-20.9%) absolute risk reduction in mortality to 10.9% (95% confidence interval, 4.7-16.2%) when reliability declined to moderate (κ = 0.51). In cohort studies, the effect on risk factor associations was similar. ARDS measurement error can seriously degrade statistical power and effect size estimates of clinical studies. The reliability of ARDS measurement warrants careful attention in future ARDS clinical studies.

Diagnostic workup for ARDS patients.

Acute respiratory distress syndrome (ARDS) is defined by the association of bilateral infiltrates and hypoxaemia following an initial insult. Although a new definition has been recently proposed (Berlin definition), there are various forms of ARDS with potential differences regarding their management (ventilator settings, prone positioning use, corticosteroids). ARDS can be caused by various aetiologies, and the adequate treatment of the responsible cause is crucial to improve the outcome. It is of paramount importance to characterize the mechanisms causing lung injury to optimize both the aetiological treatment and the symptomatic treatment. If there is no obvious cause of ARDS or if a direct lung injury is suspected, bronchoalveolar lavage (BAL) should be strongly considered to identify microorganisms responsible for pneumonia. Blood samples can also help to identify microorganisms and to evaluate biomarkers of infection. If there is no infectious cause of ARDS or no other apparent aetiology is found, second-line examinations should include markers of immunologic diseases. In selected cases, open lung biopsy remains useful to identify the cause of ARDS when all other examinations remain inconclusive. CT scan is fundamental when there is a suspicion of intra-abdominal sepsis and in some cases of pneumonia. Ultrasonography is important not only in evaluating biventricular function but also in identifying pleural effusions and pneumothorax. The definition of ARDS remains clinical and the main objective of the diagnostic workup should be to be focused on identification of its aetiology, especially a treatable infection.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-016-4324-5) contains supplementary material, which is available to authorized users.

What's new in ARDS: ARDS also exists in resource-constrained settings.

What's new in ARDS: ARDS also exists in resource-constrained settings.

Acute Respiratory Distress Syndrome and Lung Protection

Hypoxemic respiratory failure, frequently termed acute respiratory distress syndrome (ARDS), is 1 of the classic problems confronting the clinician using mechanical ventilation. Multiple trials over recent decades have identified the manipulation of mean airway pressure as the essential intervention to improve oxygenation. The easiest method to increase mean airway pressure (that the clinician can titrate) is increasing the positive end-expiratory pressure (PEEP). We have also learned that alveolar pressure rises with a consistent tidal volume and increasing PEEP. Key studies reviewed in the last column identify the value of reducing tidal volume and maintaining static alveolar pressure, measured as plateau pressure less than 30 cm H2O. If tidal volume is reduced, patients may develop a degree of hypercarbia because of reduced minute ventilation (defined as respiratory rate tidal volume). In general, reduced minute ventilation will cause the pH to decrease. Most critical care providers would accept a pH as low as 7.20 reflecting reduced minute ventilation and respiratory acidosis. Clinician must strike a balance between adequate ventilation and acid/base protection for the patient and the need to increase mean airway pressure while avoiding excessive airway pressure through the increase in PEEP with a reduction in the tidal volume. The articles discussed in this column describe current definitions for ARDS, review important comanagement strategies, and present physiologic causes for injury to the lungs by mechanical ventilation as reflected in the failure of recent trials involving high-frequency oscillatory ventilation (HFOV).

Current incidence and outcome of the acute respiratory distress syndrome.

This article discusses recently published articles reporting the incidence and outcome of patients with the acute respiratory distress syndrome (ARDS). This is a difficult task since there is a marked variability regarding the methodology of the few, large epidemiological, and observational studies on ARDS. The review will mainly focus on publications from the past 18 months. We have reviewed new epidemiological studies reporting population-based incidence of ARDS. Also, we have reviewed the data on survival reported in observational and randomized controlled trials, discussed how the current ARDS definition modifies the true incidence of ARDS, and briefly mentioned recent approaches that appear to improve ARDS outcome. On the basis of current evidence, it seems that the incidence and overall hospital mortality of ARDS has not changed substantially in the last decade. Independent of the definition used for identification of ARDS patients, reported population-based incidence of ARDS is an order of magnitude lower in Europe than in the USA. Current hospital mortality of combined moderate and severe ARDS reported in observational studies is greater than 40%.

Distrés respiratorio agudo: del síndrome a la enfermedad

The acute respiratory distress syndrome (ARDS) is currently one of the most important critical entities given its high incidence, rate of mortality, long-term sequelae and non-specific pharmacological treatment.The histological hallmark of ARDS is diffuse alveolar damage (DAD). Approximately 50% of ARDS patients present DAD, the rest is made up of a heterogeneous group of histological patterns, many of which correspond to a well-recognized disease. For that reason, if these patterns could be diagnosed, patients could benefit from a treatment.Recently, the effect of DAD in clinical and analytical evolution of ARDS has been demonstrated, so the classical approach to ARDS as an entity defined solely by clinical, radiological and gasometrical variables should be reconsidered.This narrative review aims to examine the need to evolve from the concept of ARDS as a syndrome to ARDS as a specific disease. So we have raised 4 critical questions: a) What is a disease?; b) what is DAD?; c) how is DAD considered according to ARDS definition?, and d) what is the relationship between ARDS and DAD?

Aetiology, outcomes & predictors of mortality in acute respiratory distress syndrome from a tertiary care centre in north India.

Background & objectives:Acute respiratory distress syndrome (ARDS) is a common disorder in critically ill patients and is associated with high mortality. There is a paucity of literature on this condition from developing countries. This prospective observational study was designed to find out the aetiology, outcomes and predictors of mortality in ARDS.Methods:Sixty four consecutive patients who satisfied American-European Consensus Conference (AECC) definition of ARDS from medical Intensive Care Unit (ICU) of a tertiary care centre in New Delhi, India, were enrolled in the study. Demographic, biochemical and ventilatory variables were recorded for each patient. Baseline measurements of serum interleukin (IL)-1β, IL-6, tumour necrosis factor-alpha (TNF-α), procalcitonin (PCT) and high sensitivity C-reactive protein (hsCRP) were performed.Results:Common causes of ARDS included pneumonia [44/64 (68.7%)], malaria [9/64 (14.1%)] and sepsis [8/64 (12.5%]. Eight of the 64 (12.5%) patients had ARDS due to viral pneumonia. The 28-day mortality was 36/64 (56.2%). Independent predictors of mortality included non-pulmonary organ failure, [Hazard ratio (HR) 7.65; 95% CI 0.98-59.7, P=0.05], Simplified Acute Physiology Score (SAPS-II) [HR 2.36; 95% CI 1.14-4.85, P=0.02] and peak pressure (Ppeak) [HR 1.13; 95% CI 1.00-1.30, P = 0.04] at admission.Interpretation & conclusions:Bacterial and viral pneumonia, malaria and tuberculosis resulted in ARDS in a considerable number of patients. Independent predictors of mortality included non-pulmonary organ failure, SAPS II score and Ppeak at baseline. Elevated levels of biomarkers such as TNF-α, PCT and hsCRP at admission might help in identifying patients at a higher risk of mortality.

Hospital Incidence and Outcomes of the Acute Respiratory Distress Syndrome Using the Kigali Modification of the Berlin Definition

Estimates of the incidence of the acute respiratory distress syndrome (ARDS) in high- and middle-income countries vary from 10.1 to 86.2 per 100,000 person-years in the general population. The epidemiology of ARDS has not been reported for a low-income country at the level of the population, hospital, or intensive care unit (ICU). The Berlin definition may not allow identification of ARDS in resource-constrained settings. To estimate the incidence and outcomes of ARDS at a Rwandan referral hospital using the Kigali modification of the Berlin definition: without requirement for positive end-expiratory pressure, hypoxia cutoff of SpO2/FiO2 less than or equal to 315, and bilateral opacities on lung ultrasound or chest radiograph. We screened every adult patient for hypoxia at a public referral hospital in Rwanda for 6 weeks. For every patient with hypoxia, we collected data on demographics and ARDS risk factors, performed lung ultrasonography, and evaluated chest radiography when available. Forty-two (4.0%) of 1,046 hospital admissions met criteria for ARDS. Using various prespecified cutoffs for the SpO2/FiO2 ratio resulted in almost identical hospital incidence values. Median age for patients with ARDS was 37 years, and infection was the most common risk factor (44.1%). Only 30.9% of patients with ARDS were admitted to an ICU, and hospital mortality was 50.0%. Using traditional Berlin criteria, no patients would have met criteria for ARDS. ARDS seems to be a common and fatal syndrome in a hospital in Rwanda, with few patients admitted to an ICU. The Berlin definition is likely to underestimate the impact of ARDS in low-income countries, where resources to meet the definition requirements are lacking. Although the Kigali modification requires validation before widespread use, we hope this study stimulates further work in refining an ARDS definition that can be consistently used in all settings.

MDCT in ARDS: A single center experience

Acute respiratory distress syndrome (ARDS) is a clinical condition first described by Ashbaugh et al in 1967 using the term ?adult respiratory distress syndrome?1. In order to establish a diagnosis of ARDS, radiological findings are necessary and they serve as one of the postulates. According to the latest definition, which was created by a panel of experts in 2011 in Berlin, thus termed the Berlin definition of ARDS, ARDS2 is a condition starting within 1 week of clinical insult with bilateral infiltrates detectable by chest imaging (either conventional radiography or multidetector computed tomography (MDCT) scan of lungs) and severe hypoxemia in the absence of evidence for cardiogenic pulmonary edema or fluid overload. It is necessary to explain the origin of edema, and to do that we need objective assessment (e.g., echocardiography) in order to exclude cardiogenic factors. Severity of ARDS is based on ratio between partial oxygen pressure in arterial blood and fraction of oxygen in the inspired air (PaO2 /FIO2) on 5 cm of continuous positive airway pressure (CPAP). The 3 categories are mild (PaO2/FIO2 200-300), moderate (PaO2/FIO2 100-200) and severe (PaO2/FIO2 =100). The definition itself says that in order to make a diagnosis we must do radiology imaging, although it does not say which one should be performed, the conventional radiography or MDCT. ARDS represents a stereotypic response to many different inciting insults and goes through a number of different phases, from alveolar capillary damage to lung resolution or a fibro-proliferative and fibrotic phase. The pulmonary epithelial and endothelial cellular damage is characterized by inflammation, apoptosis, necrosis and increased alveolar capillary permeability, which lead to development of alveolar edema. Purpose and role of radiographic methods is to assist in the visualization of above mentioned pathomorphological substrate. Because of the fact that sensitivity of conventional radiography is significantly lower than that of MDCT imaging, MDCT could be the primary method of choice in the initial diagnosis, but for the patient with ARDS it is most important that he has the best conditions concerning mechanical ventilation, which is very complicated to provide during the transportation of the patient from intensive care unit to MDCT diagnostic unit. As the disease evolves inside the lung area, some of the complications can be visualized only with MDCT. That is one of the main reasons MDCT is used for that period of disease evolution. Because of everything that is mentioned above, it is hard to decide whether and when MDCT scan should be performed.

Accuracy of tension and saturation-based oxygen indices in the assessment of disease severity and its progress in adults with acute respiratory distress syndrome

Objective: The goal of this study was to assess the reliability of different tension and saturation-based oxygen indices with traditional oxygenation index (OI) in the assessment of disease severity and its progress in adult patients with acute respiratory distress syndrome (ARDS) when compared to the standard arterial oxygen tension (PaO 2 )/inspired fraction of oxygen (FiO 2 ) (PF) ratio included in the Berlin definition of ARDS; the primary objective was assessed by the correlation of different OIs to the standard PF index. Design: This was a prospective, observational study. Setting: This study was carried out in Intensive Care Unit (ICU) in a university hospital. Patients and Methods: Sixty adult patients with different grades of ARDS severity according to Berlin definition were enrolled in this study. Measurements: The following indices were measured: (1) PF, (2) OI = FiO 2 × mean airway pressure [MAP] × 100/PaO 2 , (3) oxygen saturation index (OSI) = FiO 2 × MAP × 100/oxygen saturation by pulse oximeter. The primary outcome measurement was the correlation of different OIs to the standard PF index. The secondary outcome measurements were sensitivity and specificity of each index. Results: There were a strong significant negative correlation between OI and OSI with the PF ( r = −0.9 and −0.91, respectively) and a significant positive correlation between OI and OSI ( r = 0.93). Total mortality rate was 36% (22 patients). The PF, OI, and OSI were sensitive and specific (sensitivity: 0.63, 0.77, and 0.81, respectively, and specificity: 0.76, 0.86, and 0.78, respectively). Conclusion: OSI can be used as a noninvasive index for the assessment of ARDS severity in adults as it correlates significantly with PF ratio and OI with high sensitivity and specificity to predict ICU mortality.

The ratio of Th17/Treg cells as a risk indicator in early acute respiratory distress syndrome.

IntroductionRecent studies have revealed that lung inflammation mediated by CD4+ T cells may contribute to the pathogenesis of acute respiratory distress syndrome (ARDS). The imbalance between CD4 + CD25 + Foxp3 + regulatory T (Treg) cells and T helper (Th)17 cells has been found in a number of different inflammation and autoimmune diseases, while the role of the Th17/Treg balance in ARDS remains largely unknown. The aim of this study was to investigate the Th17/Treg pattern and its impact on disease severity and outcomes in patients with ARDS.MethodsThis prospective, observational study enrolled 79 patients who fulfilled the Berlin definition of ARDS and 26 age- and sex-matched healthy controls. Circulation Th17 and Treg cell frequencies were analyzed by flow cytometry, and the expressions of Th17- and Treg-related cytokines in serum were measured by enzyme-linked immunosorbent assay (ELISA). Acute Physiologic and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, and the Lung Injury Score were also calculated at enrollment.ResultsWithin 24 hours after the onset of ARDS, the changes of peripheral circulating Th17 and Treg cell frequencies gradually increased from mild to severe ARDS. Th17/Treg ratio was positively correlated with APACHE II score, SOFA score, and Lung Injury Score, while negatively correlated with PaO2/FiO2. The areas under the receiver operating characteristic (AUC) curves of Th17/Treg ratio for predicting 28-day mortality in ARDS patients was higher than that of APACHE II score, SOFA score, Lung injury score, as well as PaO2/FiO2. Using a Th17/Treg ratio cutoff value of >0.79 to determine 28-day mortality, the sensitivity was 87.5% with 68.1% specificity. Multivariate logistic regression showed Th17/Treg ratio >0.79 (odds ratio = 8.68, P = 0.002) was the independent predictor for 28-day mortality in patients with ARDS. Finally, cumulative survival rates at 28-day follow-up also differed significantly between patients with Th17/Treg ratio >0.79 and ≤0.79 (P <0.001).ConclusionsThe Th17/Treg imbalance favoring a Th17 shift represents a potential therapeutic target to alleviate lung injury and a novel risk indicator in patients with early ARDS.

Risk factor analysis of postoperative acute respiratory distress syndrome in valvular heart surgery

PurposeThe aim of this study is to investigate the incidence, severity, and outcome of postoperative acute respiratory distress syndrome (ARDS), according to the Berlin definition, in isolated valvular heart surgery. The preoperative and perioperative predisposing factors of this complication were also identified. MethodsA retrospective chart review was conducted on 457 patients who underwent isolated valvular heart surgery between January 2010 and December 2012. Clinical characteristics and outcomes were collected. The primary outcome was postoperative ARDS, according to the 2012 Berlin definition for ARDS. ResultsA total of 37 patients (8.1%) developed postoperative ARDS, with a mortality rate of 29.7%. The multivariate analysis identified that age (odds ratios [ORs], 1.067, P ≤ .001), liver cirrhosis (OR, 7.159; P = .001), massive blood transfusion (OR, 2.980; P = .005), and tricuspid valve replacement (OR, 5.197; P = .012) were independent risk factors of postoperative ARDS. Furthermore, we have determined that the increased severity stages of ARDS were associated with decreased postoperative survival. ConclusionsIn conclusion, postoperative ARDS, according to Berlin definition, in valvular surgery, was associated with high in-hospital mortality. The severity of ARDS was associated with patient midterm mortality. In multivariate analysis, age, liver cirrhosis, massive blood transfusion, and tricuspid valve replacement were identified as independent risk factors of ARDS.

Epidemiology and outcomes of acute respiratory distress syndrome in children according to the Berlin definition: a multicenter prospective study.

In 2012, a new acute respiratory distress syndrome definition was proposed for adult patients. It was later validated for infants and toddlers. Our objective was to evaluate the prevalence, outcomes, and risk factors associated with acute respiratory distress syndrome in children up to 15 years according to the Berlin definition. A prospective, multicenter observational study from March to September 2013. Seventy-seven PICU beds in eight centers: two private hospitals and six public academic hospitals in Brazil. All children aged 1 month to 15 years admitted to the participating PICUs in the study period. None. All children admitted to the PICUs were daily evaluated for the presence of acute respiratory distress syndrome according to the American-European Consensus Conference and Berlin definitions. Of the 562 patients included, acute respiratory distress syndrome developed in 57 patients (10%) and 58 patients (10.3%) according to the Berlin definition and the American-European Consensus Conference definition, respectively. Among patients with acute respiratory distress syndrome according to the Berlin definition, nine patients (16%) were mild, 21 (37%) were moderate, and 27 (47%) were severe. Compared with patients without acute respiratory distress syndrome, patients with acute respiratory distress syndrome had significantly higher severity scores, longer PICU and hospital length of stay, longer duration of mechanical ventilation, and higher mortality (p < 0.001). The presence of two or more comorbidities and admission for medical reasons were associated with development of acute respiratory distress syndrome. Comparisons across the three the Berlin categories showed significant differences in the number of ventilator-free days (21, 20, and 5 d, p = 0.001) and mortality for severe acute respiratory distress syndrome (41%) in comparison with mild (0) and moderate (15%) acute respiratory distress syndrome(p = 0.02). No differences in PICU or hospital stay were observed across the groups. The Berlin definition can identify a subgroup of patients with distinctly worse outcomes, as shown by the increased mortality and reduced number of ventilator-free days in pediatric patients with severe acute respiratory distress syndrome.

Mechanisms and clinical consequences of acute lung injury.

Acute respiratory distress syndrome (ARDS) was first described in 1967, and since then there have been a large number of studies addressing its pathogenesis and therapies. Despite intense research efforts, very few therapies for ARDS have been shown to be effective other than the use of lung protection strategies. The scarcity of therapeutic choices is related to the intricate pathogenesis of the syndrome and to insensitive and aspecific criteria to diagnose this profound acute respiratory failure. The aim of this paper is to summarize advances of new ARDS definitions and provide an overview of new relevant signaling pathways that mediate acute lung injury.

Acute respiratory distress syndrome in an 11-month-old girl leading to extracorporeal membrane oxygenation

Acute respiratory distress syndrome (ARDS) is a condition recognised for al-most fifty years, and is related to high mor-bidity and mortality in children. From its recognition, medical experts tried to make joint efforts to make recommendations and optimize treatment in children and adult population. The new definition of ARDS suggests treatment by introducing three levels of severity, according to PaO2/FiO2 and positive end-expiratory pres-sure. Lung-protective ventilation remains crucial in achieving better outcome in pae-diatric acute respiratory distress syndrome (PARDS), but promising therapies based on paediatric studies include non-invasive ventilation, endotracheal surfactant, high-frequency oscillatory ventilation (HFOV), and use of ECMO as „rescue“ therapy. Nevertheless, PARDS is a real challenge for the paediatric critical care provider, and even if current state-of-the-art treatment methods are delivered, this disease often leads to fatal outcome. We report the case of an 11-month-old female infant who developed ARDS, was treated by current up-to-date treatment methods, including ECMO, and despite this, succumbed to her illness. With this case report we would like once more to bring to consideration the current knowl-edge on etiology, epidemiology, diagnosis and treatment of ARDS in children, and emphasize the high morbidity and mortal-ity related to this syndrome.

Non-ventilator therapy in pediatric acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) is one of the most severe disease in pediatric intensive care units. The purpose of this article is to introduce the Berlin′s definition of ARDS and review the current knowledge base related to non-ventilator therapy in pediatric intensive care unit, including prevention of predisposing factor, nutrition therapy, conservative fluid therapy, transfusion and transfusion related acute lung injury, etc. The article also reviews the role of pulmonary surfactant, nitric oxide, prone position and glucocorticoid in pediatric ARDS. Key words: Acute respiratory distress syndrome; Treatment; Children

Acute respiratory distress syndrome: Implications of recent studies.

Acute respiratory distress syndrome (ARDS) remains challenging to diagnose and manage. This article reviews the new definition of ARDS and the key findings of landmark studies over the last 5 years of prone-position ventilation, high-frequency oscillatory ventilation (HFOV), extracorporeal membrane oxygenation (ECMO), and neuromuscular blockade in patients with ARDS.