Acute Respiratory Distress Syndrome in Children

Yıl 2009, Cilt: 18 Sayı: 4, 241 - 259, 01.12.2009

Dinçer Yıldızdaş Özden Özgür Horoz Ali Ertuğ Arslanköylü Müge Sağıroğlu

Öz

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are an important challenge for pediatric intensive care units. These disorders are characterized by a significant inflammatory response to a local (pulmonary) or remote (systemic) insult resulting in injury to alveolar epithelial and endothelial barriers of the lung, acute inflammation and protein rich pulmonary edema. The reported rates in children vary from 8.5 to 16 cases/1000 pediatric intensive care unit (PICU) admissions. The pathological features of ARDS are described as passing through three overlapping phases-an inflammatory or exudative phase (0-7 days), a proliferative phase (7-21 days) and lastly a fibrotic phase. The treatment of ARDS rests on good supportive care and control of initiating cause. Ventilatory modes and nursing interventions to optimize patient outcomes are identified. The goal of ventilating patients with ALI/ARDS should be to maintain adequate gas exchange. Lung protective mechanical ventilation with optimal lung recruitment is the mainstay of supportive therapy. This can be achieved by use of optimum PEEP, low tidal volume and appropriate FiO2. New therapeutic modalities refer to corticosteroid, high frequency ventilation, inhaled nitric oxide, prone positioning and surfactant treatment. Well-designed follow up studies are needed.

Anahtar Kelimeler

Acute respiratory distress syndrome, children

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

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