Evaluation of paediatric patients with acute respiratory distress syndrome (ARDS) In Paediatric Intensive Care Unit,C.U.T.F., between 2006-2008

Background and Aims: In this study we aimed to determine the incidence, the etiologic factors, complications, treatment protocols, frequency of multiorgan dysfunction (MODS) and mortality rate in ARDS in Paediatric Intensive Care Unit (PICUMaterial and Methods: 65 patients with ARDS were included in this study. 35 of patients were suffered from pulmonary ARDS and 30 of suffered from extrapulmonary ARDS. 33 of patients were ventilated by high frequency oscillatory ventilation (HFOV) after conventional ventilation. Similarly; the patients with ARDS were classified to pulmonary and extrapulmonary ARDS groups.The demographic peculiarities and etiologic factors of ARDS, arterial blood gas values, the parameters of mechanical ventilation, sedation-analgesia and muscle relaxing agents need and the score of critical care (PRISM II), PaO2/FiO2 ratio, Murray index, oxygenation index (OI) and AaDO2 complications of ARDS, ratio of multiorgan dysfunction syndrome (MODS) and mortality rate were determinedResults: The incidence of ARDS was determined as 4.6%, MODS ratio was 72% and mortailty rate was 40% in PICU. Malignancy and trauma were the most important predispozing factors underlying ARDS. 35 of patients with ARDS suffered from pulmonary ARDS and 30 of suffered from extrapulmonary ARDS. When we compared pulmonary and extrapulmonary ARDS groups, there were no significant differences in PaO2/FiO2 ratio, OI, Murray index and AaDO2 at the time of ARDS diagnosis (for all of them, p>0.05).Also MODS and mortality ratios were similar in two groups (both, p>0.05). 33 of 65 patients with ARDS were ventilated by HFOV after conventional ventilation. After switching to HFOV, the PaO2/FiO2 ratio increased (p<0.05) and OI decreased (p<0.05). When the patients with ARDS ventilated by HFOV were classified to pulmonary and extrapulmonary groups, there was an increase in PaO2/FiO2 ratio (p<0.05) and decrease in OI (p<0.05) in extrapulmonary ARDS group. However the mortality rate was significantly lower in extrapulmonary ARDS group (p<0.05Conclusion: We detected HFOV improves oxygenation in patients with ARDS, so we may conclude that if there is no improvement of oxygenation on convansional ventilation, HFOV can be used. In addition, HFOV seems to be more effective in patients with extrapulmonary ARDS. But more randomized controlled prospective trials are needed to identify the effectiviness of HFOV in ARDS patients.Keywords: Acute respiratory distress syndrome, mechanical ventilation, pulmonary andextrapulmonary ARDS, high frequency oscillatory ventilation (YFOV), mortality, child.