Çocuklarda Akut Respiratuar Distres Sendromu

Dinçer Yıldızdaş; Özden Özgür Horoz; Ali Ertuğ Arslanköylü; Müge Sağıroğlu

EN TR

Çocuklarda Akut Respiratuar Distres Sendromu

Öz

Akut akciğer hasarlanması ve akut respiratuar distress sendromu Çocuk Yoğun Bakım Üniteleri'nin önemli sorunlarından biridir. Bu iki durum, aşırı lokal veya sistemik inflamatuar cevap sonucu alveolar epitel ve akciğerin endotel bariyerinde hasarlanma sonucu ortaya çıkan akut inflamasyon ve proteinden zengin pulmoner ödem ile karakterizedir. Çocuk Yoğun Bakım Üniteleri'ne yatan hastalarda rapor edilen oran 8.5 ile 16 olgu/1000'dir. Akut respiratuar distress sendromu birbirine overlap yapan üç fazı olup-inflamatuar veya eksudatif faz (0-7 gün), proliferatif faz (7-21 gün) ve son olarakta fibrotik fazdır. Akut respiratuar distress sendromunun tedavisi iyi supportif bakım ve altdaki primer nedenin tedavisidir. Akut respiratuar distress sendromunun ventilatör tedavisindeki amaç yeterli gaz değişiminin sağlanmasıdır. Ana tedavi prensibi ise akciğeri koruyucu mekanik ventilasyon ile beraber optimal hacim kazandırma olmalıdır. Bu durum optimal PEEP, düşük tidal volüm ve uygun FiO2 kullanımı ile sağlanır. Yeni tedavi modaliteleri ise kortikosteroid, yüksek frekanslı ventilasyon, inhale nitrik oksit, prone pozisyonu ve sürfaktandır. Ancak çok daha fazla çalışmaya ihtiyaç vardır.

Anahtar Kelimeler

Akut respiratuvar distress sendromu, çocuk

Kaynakça

Ashbaugh DG, Bigelow DB, Petty TL, et al. Acute respiratory distress in adults. Lancet 1967;2:319-23.
Bernard GR, Artigas A, Brigham KL, et al. The American- European Consensus Conference on ARDS; definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149:818-24.
Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of ARDS. Am Rev Respir Dis 1988;138:720-3.
National Heart Lung Institute; Task force report on problems, research approaches, needs. NIH Publication No. 73-432. Washington , DC: National Heart Institute;1972:165-180.
Artigas A, Bernard GR, Carlet J, et al. The American- European Consensus Conference on ARDS, Part 2. Am J Respir Care Med 1998;157:1332-47.
Parsons PE. Mediators and mechanism of acute lung injury. Clin Chest Med 2000; 21: 467-76.
Martin TR. Lung cytokines and ARDS. Chest 1999;116( Suppl 1): 25-85.
Paret G, Ziv T, Barzilai A, Ben-Abraham R, Vardi A, et al. Manisterski Y. Ventilation index and outcome in children with acute respiratory distress syndrome. Pediatr Pulmonol 1998;26(2):125-128.
Davis SL, Furman DP, Costarino A. Adult respiratory distress syndrome in children: Associated disease, clinical course, and predictors of death. J Pediatr 1993;123(1):35-45.
Fein AM, Lippmann M, Holtzman H, et al. The risk factors, incidence, and prognosis of ARDS following septisemia. Chest 1983;83(1):40-42.

Gattinoni L, Caironi P, Pelosi P, et al. What has computed tomography taught about the acute respiratory distress syndrome. Am J Respir Crit Care Med 2001; 164: 1701-1711.
Gillette MA, Hess DR. Ventilator-induced lung injury and the evalution of lung-protective strategies in acute respiratory distress syndrome. Am J Respir Care Med 2001;46: 130-148 . 13. Amat B, Barcons M, Mancebo J, et al. Evolution of leukotriene B4, peptide leukotrienes, and Interleukin-8 plasma concentrations in patient at risk of acute respiratory distress syndrome; mortality prognostic study. Crit Care Med 2000;28:57-62.
The National Heart, Lung and Blood Institute ARDS Clinical Trials Network. Higher versus lower positive end- expiratory pressures in patients with the acute respiratory distress syndrome. N Eng J Med 2004; 351:327-36.
The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Eng J Med 2000; 342: 1301-8.
Stewart TE, Meade MO, Cook DJ, et al. Evaluation of a ventilation strategy to prevent barotravma in patients at high risk for acute respiratory distress syndrome. N Eng J Med 1998; 338: 355-61.
Brower RG, Shanholtz CB, Fesler HE, et al. Prospective, randomized, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients. Crit Care Med 1999;27:1661-8.
Lapinsky SE, Aubin M, Mehta S, et al. Safety and efficiacy of a sustained inflation for alveolar recruitment in adults with respiratory failure. Intensive Care Med 1999;25(11): 1297-1301.
Povoa P, Almeida E, Fernandes A, et al. Evaluation of a recruitment maneuver with positive inspiratory pressure and high PEEP in patients with severe ARDS. Acta Anaesthesiol Scand 2004;4: 287-92.
Lachmann B. Open up the lung and keep the lung open. Intensive Care Med 1992;18:319-21.
Hickling KG, Hewnderson SJ, Jackson R. Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med 1990; 16: 372-7.
Rothen TN, Sporre B, Engberg G, et al . Reexpansion of atelectasis during general anesthesia may have a prolonged effect. Acta Anaesthesial Scand 1995;39: 118-25.
Pelosi P, Cadringher P, Bottino N, et al. Sigh in acute respiratory distress syndrome. Am J Respir Crit Care Med 1999; 159: 872-80.
Turner JS, Smith G, Theunissen D. Prone position for ventilation in patients with severe adult respiratory distress syndrome. S Afr Med J. 1994; Nov; 84(11 Suppl): 803-6.
Hallman M, Spragg R, Harell JH, et al. Evidence of lung surfactant abnormality in respiratory failure. Study of bronchoalveolar lavage phospholipids, surface activity and plasma myoinositol. J Clin Invest 1982;70: 673-683.
Günther A, Ruppert C, Schmidt R, et al. Surfactant alteration and replacement in acute respiratory disress syndrome. Respir Res 2001;2:353-64.
Möller DC. Surfactant treatment for acute respiratory distress syndrome (infantil ARDS). In: Waver RR, editor. Surfactant therapy: basic principles, diagnosis, therapy. Georg Thiema Verlag: Stutgardt; 1998:133-45.
Anzueto A, Boughman RD, Guntupalli KK, et al. Forth Exosurf Acute Respiratory Distress Syndrome Sepsis Study Group: Aerosolized surfactant in adults with sepsis- induced acute respiratory distress syndrome. N Eng J Med 1996; 334;1417-1421.
Möller JC, Schaible T, Roll C, et al and the Surfactant ARDS Study Group. Treatment with bovine surfactant in severe acute resoiratory distress syndrome in children: a randomized multicenter study. Intensive Care Med 2003; 29: 437-446.
Yapicioglu H, Yildizdas D, Bayram I, et al HL. The use of surfactant in children with acute respiratory distress syndrome: Efficicacy in terms of oxygenation, ventilation and mortality. Pulm Pharm Ther 2003;16:327-333.
Ogura H, Cioffi WG, Offner PJ, et al. Effect of inhaled NO on pulmonary function following sepsis in a swin model. Surgery 1994; 116:313-21.
Rossaint R, Falke KJ, Lopez F, et al. Inhaled nitric oxide for the adult respiratory distress syndrome . N Eng J Med 1993;328:399-405.
Pison V, Lopez FA, Heidelmeyer CF, et al. Inhaled nitric oxide reverses hypoxic pulmonary vasoconstriction without impairing gas exchange. J Appl Physiol 1993;74: 1287-1292.
Sokol J, Jacobs SE, Bohn D. Inhaled nitric oxide for acute respiratory failure in children and adults: a meta-analysis. Anesth Analg 2003;97:988-99.
Hooper RG, Kearl RA. Established ARDS treated with a sustained course of adrenocortical steroids. Chest 1990;97:138-43.
Meduri GU, Belenchia JM, Estes RJ, et al. Fibroproliferative phase of ARDS. Clinical findings and effects of corticosteroids. Chest 1991; 100:943-952.
Meduri GU, Headley S, Tolley E, et al. Plasma and BAL cytokine response to corticosteroid rescue treatment in late ARDS. Chest 1995;108:1315-1325.
Meduri GU, Headley AS, Golden E, et al. Effect of prolonged methylprednisolone therapy in unresolving acute respiratory disress syndrome. JAMA 1998;280:15165.
Shoemaker WC, Apel PL, Waxmann K, et al. Clinical trial of survivors’ cardiorespiratory patterns as therapeutic goals in critically ill postoperative patients. Crit Care Med 1982;10:398-403.
Davey–Quinn A, Gedney A, Whiteley M, et al. Extravascular lung water and acute respiratory distress syndrome-oxygenation and outcome. Anaesth Intensive Care 1999;27:357-62.
Third European Consensus Conference in Intensive Care Medicine. Tissue hypoxia: How to detect, how to correct, how to prevent. American Thoracic Society Am J Respir Crit Care Med 1996;154:1573-1578.
Al-Saddy NM, Blackmore CM, Bennett ED. High fat, low carbonhydrate, enteral feding lowers. PaCO2 and reduces the period of ventilation in artificially ventilated patients. Intensive Care Med 1989; 15:290-295.
Pacht ER, Demichele SJ, Nelson JL, et al. Enteral nutrition with eicosapentaenoic acid, alph-linolenic acid, and antioxidants reduces alveolar inflamatory mediators and protein influx in patients with acute respiratory distress syndrome. Crit Care Med 2003;31:491-500.
Gadek J, DeMichele S, Karlstad M, et al. Effect of enteral feding with eicosapentaenoik acid,gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Crit Care Med 1999;27:1409-1420.

Ayrıntılar

Birincil Dil

Türkçe

Konular

-

Bölüm

-

Yazarlar

Dinçer Yıldızdaş Bu kişi benim

Özden Özgür Horoz Bu kişi benim

Ali Ertuğ Arslanköylü Bu kişi benim

Müge Sağıroğlu Bu kişi benim

Yayımlanma Tarihi

1 Aralık 2009

Gönderilme Tarihi

30 Ekim 2014

Kabul Tarihi

-

Yayımlandığı Sayı

Yıl 2009 Cilt: 18 Sayı: 4

IZ

https://izlik.org/JA28EW98HG

AMA

1.Yıldızdaş D, Horoz ÖÖ, Arslanköylü AE, Sağıroğlu M. Çocuklarda Akut Respiratuar Distres Sendromu. aktd. 2009;18(4):241-259. https://izlik.org/JA28EW98HG

Çocuklarda Akut Respiratuar Distres Sendromu

Acute Respiratory Distress Syndrome in Children

Abstract

Keywords

Çocuklarda Akut Respiratuar Distres Sendromu

Öz

Anahtar Kelimeler

Kaynakça

Ayrıntılar

Birincil Dil

Konular

Bölüm

Yazarlar

Yayımlanma Tarihi

Gönderilme Tarihi

Kabul Tarihi

Yayımlandığı Sayı

IZ

Kaynak Göster