Acute Respiratory Distress Syndrome in Children
What is it?
Acute respiratory distress syndrome (ARDS) is also
known as adult respiratory distress syndrome. It is a type
of lung failure that can occur when large amounts of fluid
accumulate in the lungs. ARDS should be treated as a
medical emergency.
Who gets it?
Children at risk for ARDS include those with infections
that commonly cause fluid to accumulate in the lungs.
What causes it?
Tiny air sacs called alveoli are located at the tips of
the body’s smallest breathing tubes, called the bronchi.
The alveoli are responsible for passing oxygen into the
blood. When the lungs are injured by infection or disease,
blood and fluid begin to leak into the alveoli. When this
happens, oxygen can’t enter the alveoli, which means
oxygen is no longer getting into the blood. Because the
lungs are inflamed and filled with fluid, the patient
finds it increasingly difficult to breathe. The
inflammation in the lungs leads to scarring, which is
called fibrosis. The lungs eventually become stiff with
scar tissue and breathing becomes very difficult. There
are many possible causes of the type of lung injury that
leads to ARDS. These include inhaling high concentrations
of toxins or oxygen; severe burns; blood infection
(sepsis); pneumonia; pancreatitis; fat embolism; or trauma
to other parts of the body. Fluids can also get into the
lungs and cause injury when they are breathed in
(aspirated), such as in a near drowning or when a person
who is unconscious vomits.
What are the symptoms?
A patient will usually develop ARDS within 24 to 48
hours of the original illness or injury. Symptoms include
difficult, shallow, rapid breathing; feelings of anxiety;
and low blood oxygen. Patients with fluid in the lungs
will usually have a “crackling” and wheezing sound in the
lungs that can be heard with a stethoscope. Because the
blood oxygen is so low, the patient’s skin may look
mottled or blue. In severe cases, low blood oxygen causes
other organ systems, such as the liver, kidneys, heart,
and brain, to fail.
How is it diagnosed?
To diagnose ARDS, a doctor will check the level of
oxygen in the child’s blood either through a blood test
called an arterial blood gas, or by using a device called
an oximeter, which is clipped to the earlobe. A chest
x-ray will show if there is any fluid in the lungs. It is
important to determine the underlying cause in order to
provide a prognosis for recovery.
What is the treatment?
Children with ARDS are treated in a hospital’s
Pediatric Intensive Care Unit (PICU). They are given
oxygen through a process called positive-pressure
ventilation and positive end-expiratory pressure (PEEP) to
increase the number of alveoli that remain open. The child
is usually sedated during this treatment. The amount of
oxygen needed decreases as the lungs heal. High pressures
and high concentrations of oxygen are kept to a minimum
because they can increase lung injury and cause permanent
scarring. Some patients respond well to extracorporeal
membrane oxygenation (ECMO), which is a machine that takes
over the functions of the heart and lungs until the lungs
have healed enough to function normally. Medications, such
as antibiotics and steroids, may also be used to treat
infections and reduce inflammation. During treatment,
intravenous fluids are given to prevent dehydration and
provide nutrition. Renal, liver, and gastrointestinal
functions are closely monitored because organ failure is
common in advanced ARDS. The outlook for recovery depends
upon the underlying cause, the timing of treatment, and
the patient’s response to treatment.
Self-care tips
Children with any type of lung infection should receive
prompt treatment to avoid ARDS. Without immediate
treatment, patients with ARDS will die. Patients on oxygen
therapy should receive the lowest level necessary because
high concentrations of oxygen can result in lung damage.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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