Division of Pediatric Critical Care, University of Alabama, Birmingham, AL 35233, USA.
Indian Pediatr. 2010 Oct;47(10):861-8. doi: 10.1007/s13312-010-0144-9.
Acute respiratory distress syndrome (ARDS) is a common diagnosis among children admitted to pediatric intensive care units. This heterogeneous disorder has numerous pulmonary and non-pulmonary causes and is associated with a significant risk of mortality. Many supportive therapies exist for ARDS. SEARCH: Literature search was performed by using the key words ARDS and related topics on the Pubmed search engine maintained by the National Heart, Lung, Blood Institute. Pediatric randomized controlled trials that have been published in the last 10 years were included. Emphasis was placed on pediatric literature, although sentinel adult studies have been included. Most of the evidence presented is of levels I and II.
Low tidal volume is the only strategy that has consistently improved outcome in ARDS. A tidal volume of ≤ 6 mL/kg predicted body weight should be used. Ventilator induced lung injury may result in systemic effects with multi-system organ failure, and all efforts should be made to minimize this. Positive end-expiratory pressure should be used to judiciously maintain lung recruitment. There is insufficient evidence to routinely use high frequency ventilation, prone positioning, or inhaled nitric oxide. Calfactant therapy is promising and may be considered in children with direct lung injury and ARDS. Current literature does not support routine use of corticosteroids for non-resolving ARDS.
急性呼吸窘迫综合征（ARDS）是儿童入住儿科重症监护病房的常见诊断。这种异质性疾病有许多肺部和非肺部原因，与死亡率显著升高相关。ARDS 有许多支持性治疗方法。
使用国家心肺血液研究所维护的 Pubmed 搜索引擎上的关键词“ARDS”和相关主题进行文献检索。纳入了过去 10 年发表的儿科随机对照试验。重点是儿科文献，尽管也纳入了一些主要的成人研究。所呈现的大部分证据都是 I 级和 II 级。
低潮气量是唯一一致改善 ARDS 结局的策略。应使用预测体重的潮气量≤6ml/kg。呼吸机所致肺损伤可能导致多系统器官衰竭的全身效应，应尽力减少这种效应。应使用呼气末正压（PEEP）来明智地维持肺复张。目前尚无充分证据常规使用高频通气、俯卧位或吸入一氧化氮。表面活性物质治疗有前途，对于直接肺损伤和 ARDS 的患儿可考虑使用。目前的文献不支持常规使用皮质激素治疗非进展性 ARDS。
