Pfenninger J, Gerber A, Tschäppeler H, Zimmermann A
J Pediatr. 1982 Sep;101(3):352-7. doi: 10.1016/s0022-3476(82)80057-7.
Twenty patients (age 2 weeks to 15 years) who fulfilled strict selection criteria for adult respiratory distress syndrome were identified during a 3 1/2-year period. The underlying disease was intra-abdominal infection/septicemia in seven, hypovolemic shock, near drowning, closed space burn, or cardiogenic shock caused by nupercaine intoxication in two each, and miscellaneous in five. The mean time of artificial ventilation with PEEP was 18 days (range 5 to 92), and the mean time of FIO2 greater than or equal to 0.5 while on the ventilatory 139 hours (range 12 to 648). PEEP levels were most often between 8 and 15 cm H2O. Eight patients had a pulmonary air leak. Eight patients died (40% mortality). Death was nearly always related to unresolved basic medical or surgical problems and multiple organ failure. Treatment of ARDS includes elimination of the cause of ARDS, early institution of mechanical ventilation with PEEP, prompt recognition and treatment of superimposed infections, and careful management of additional organ failures.
在3年半的时间里，确定了20例符合成人呼吸窘迫综合征严格入选标准的患者（年龄2周至15岁）。基础疾病为腹腔内感染/败血症7例，低血容量性休克、近乎溺水、封闭空间烧伤或奴夫卡因中毒引起的心源性休克各2例，其他5例。使用呼气末正压（PEEP）进行人工通气的平均时间为18天（范围5至92天），通气期间吸入氧分数（FIO2）≥0.5的平均时间为139小时（范围12至648小时）。PEEP水平大多在8至15厘米水柱之间。8例患者发生肺漏气。8例患者死亡（死亡率40%）。死亡几乎总是与未解决的基础医疗或外科问题以及多器官功能衰竭有关。急性呼吸窘迫综合征的治疗包括消除急性呼吸窘迫综合征的病因、早期使用PEEP进行机械通气、及时识别和治疗叠加感染以及仔细处理其他器官功能衰竭。
