Pediatric and Maternal Critical Care Unit, Hassan II University Hospital, Fez, Morocco.
Pan Afr Med J. 2023 Apr 26;44:201. doi: 10.11604/pamj.2023.44.201.35724. eCollection 2023.
Acute respiratory distress syndrome (ARDS) is a life-threatening condition despite medical development. Unlike adult, ARDS, in pediatric population, has been recently defined in the Pediatric Acute Lung Injury Consensus Conference (PALICC), 2015. We conduct a retrospective descriptive study, in pediatric intensive care unit (PICU) of Hassan II University Hospital during a period of 2 years (2019 to 2021) in which we included 23 pediatric cases of ARDS defined using 2012 Berlin criteria. They represent 2.7% of all patients admitted in our unit (23 patients of 850 admissions), with a male predominance 17 males/6 females, the median of age was 4.6 years-old (2 months to 14 years-old). Pediatric acute respiratory distress syndrome (PARDS) cases were stratified as mild in 13% (n=3), moderate in 52% (n=12), and severe in 35% (n=8). The etiologies were of pulmonary origin (pneumonia, aspiration, pulmonary contusion, and foreign body) in 79% of cases (n=18), and extra-pulmonary origin (sepsis, burn and major trauma) in 21% (n=5). The management was based on lung protective invasive mechanical ventilation (95%, n=22), Prone positioning was applied (26%, n=6), inhaled nitric oxide (iNO) was used in (35%, n=8), recruitment maneuvers (56%, n=13), neuromuscular blockade (NMB) (74%, n=17) and extracorporeal membrane oxygenation (ECMO) in 1 case. The outcome was favorable in 65% (n=15) with a mean PICU-stay of 20 days (SD=16 days). Overall mortality rate was 35% (n=8), and 100% (n=5) in case of extrapulmonary (indirect) etiologies. It was proportional to the disease severity, 50% (4 of 8 cases), 33% (4 of 12 cases), and no death respectively in severe, moderate, and mild PARDS. PARDS in our context is a serious problem as it is more frequent in children < 5 years, a population considered as fragile, with a high mortality rate especially in indirect lung etiologies of PARDS.
急性呼吸窘迫综合征（ARDS）尽管医学在不断发展，但仍是一种危及生命的疾病。与成人不同，儿科人群中的 ARDS 是在 2015 年小儿急性肺损伤共识会议（PALICC）中最近定义的。我们进行了一项回顾性描述性研究，在哈桑二世大学医院的儿科重症监护病房（PICU）中，对 2019 年至 2021 年期间的 23 例 ARDS 患儿进行了研究，这些患儿是根据 2012 年柏林标准定义的。这些患儿占我们科室所有住院患者的 2.7%（23 名患者/850 名住院患者），男性占优势，17 名男性/6 名女性，中位年龄为 4.6 岁（2 个月至 14 岁）。小儿急性呼吸窘迫综合征（PARDS）病例中轻度占 13%（n=3），中度占 52%（n=12），重度占 35%（n=8）。病因中肺部疾病（肺炎、吸入、肺挫伤和异物）占 79%（n=18），非肺部疾病（败血症、烧伤和重大创伤）占 21%（n=5）。治疗以肺保护性有创机械通气（95%，n=22）为主，俯卧位通气（26%，n=6），吸入一氧化氮（iNO）（35%，n=8），肺复张手法（56%，n=13），神经肌肉阻滞（NMB）（74%，n=17）和体外膜氧合（ECMO）在 1 例患者中使用。预后良好者占 65%（n=15），平均 PICU 住院时间为 20 天（SD=16 天）。总体死亡率为 35%（n=8），非肺部（间接）病因者为 100%（n=5）。死亡率与疾病严重程度成正比，严重 PARDS 中 50%（8 例中的 4 例）、中度 PARDS 中 33%（12 例中的 4 例）、轻度 PARDS 中无死亡。在我们的背景下，PARDS 是一个严重的问题，因为它在<5 岁的儿童中更为常见，这个年龄段的儿童被认为是脆弱的，死亡率很高，特别是在 PARDS 的间接肺部病因中。
