Abstract
We report 13 severely disabled children with acute respiratory distress syndrome,
who were treated at the Department of Pediatrics, Niigata City General Hospital between
1995 and 2002. The children ranged in age from 1 year to 16 years. All were non-ambulant.
Chronic aspiration and gastro-esophageal reflux were recognized in 12 patients. Patients
had the rapid onset of dyspnea refractory to oxygen therapy. Diffuse bilateral lung
infiltrates were present on chest X-ray. Predisposing events included sepsis (3 patients),
pneumomia (7 patients), pancreatitis (1 patient) and two children with other infections.
All required mechanical ventilation for periods of 3–26 days and received oxygen for
5–64 days. Steroid therapy and surfactant therapy were given to eight and three patients,
respectively. Only one patient developed an air leak complication. Despite intensive
care, three children died, one underwent tracheostomy and nine recovered completely.
Acute respiratory distress syndrome is a commonly recognized cause of acute respiratory
failure following a variety of insults. It is characterized by the acute onset of
dyspnea refractory to oxygen therapy, and diffuse lung infiltrates. Children with
severe motor and intellectual disabilities had various complications. In this study,
chronic aspiration and gastro-esophageal reflux are considered to be one of predisposing
factors triggering acute respiratory distress syndrome in children with severe motor
and intellectual disabilities. Although acute respiratory distress syndrome was considered
to be a not infrequent occurrence, its mortality rate might be low despite the severity
of the disease in children with severe motor and intellectual disabilities. Acute
respiratory distress syndrome can be a complication seen in severely disabled children.
Keywords
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References
- Acute respiratory distress in adults.Lancet. 1967; 2: 319-323
- The American–European consensus conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination.Am J Respir Crit Care Med. 1994; 149: 818-824
- Adult respiratory distress syndrome in pediatric patients. 1. Clinical aspects, pathophysiology, pathology,and mechanisms of lung injury.J Pediatr. 1988; 112: 169-180
- Adult respiratory distress syndrome in children: associated disease, clinical course, and predictors of death.J Pediatr. 1993; 123: 35-45
- Cause of death in inpatients with severe motor and mental handicaps in National Hospitals.Nihon Shonika Gakkai Zashi (in Japanese). 1994; 98: 1902-1906
- A case of adult respiratory distress syndrome treated successfully with combination of the mechanical ventilation using PEEP and methylpredonisolone pulse therapy.Iryo (in Japanese). 1991; 45: 276-281
Shibata R, Tanaka Y, Suzuki H, Nishima S. Clinical features and prognosis of asthma and acute respiratory distress syndrome in patients with severe motor and intellectual disabilities. Report on the age-dependent changes in pathophysiology and the management of severe motor and intellectual disabilities 1998. The research grant for nervous and mental disorders from the ministry of welfare (in Japanese) 231–44; 1999.
- Analysis of lung lesion in autopsied patients with severe motor and intellectual disabilities.J Severe Mot Intellect Disabil (in Japanese). 2001; 26: 15-20
- Adult respiratory distress syndrome in children.Pediatr Clin North Am. 1980; 27: 667-685
- Adult respiratory distress syndrome in children.J Pediatr. 1982; 101: 352-357
- Adult respiratory distress syndrome in a pediatric intensive care unit: predisposing conditions, clinical course, and outcome.Pediatrics. 1981; 67: 790-795
- Adult-type respiratory distress syndrome in children.Clin Pediatr. 1983; 22: 401-406
- Adult respiratory distress in adults.Radiology. 1985; 157: 69-74
- The cytologic evaluation of bronchoalveolar lavage fluid from patients with chronic aspiration involved in acute respiratory distress syndrome.Chiba Igaku (in Japanese). 1998; 74: 17-22
- Importance of diffuse aspiration bronchitis caused by chronic occult aspiration in the elderly.Chest. 1996; 110: 1289-1293
- The American–European consensus conference on ARDS. Part 2. Ventilatory, pharmacologic, supportive therapy, study design strategies, and issues related to recovery and remodeling.Am J Respir Crit Care Med. 1998; 157: 1332-1347
- Bovine surfactant therapy for patients with acute respiratory distress syndrome.Am J Respir Crit Care Med. 1997; 155: 1309-1315
- Effect of prolonged methylpredonisolone therapy in unresolving acute respiratory distress syndrome.J Am Med Assoc. 1998; 280: 159-165
Article info
Publication history
Accepted:
September 28,
2004
Received in revised form:
September 28,
2004
Received:
October 20,
2003
Identification
Copyright
© 2004 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
