Respiratory Distress Syndrome Case Study

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TERMINOLOGY
CLINICAL CLARIFICATION
• Acute respiratory distress syndrome {ARDS) is a condition of dysfunctional gas exchange {i.e., pulmonary interstitial and alveolar edema progressing to advanced fibrosis) that is characterized by acute onset, bilateral pulmonary infiltrates, severe hypoxia, the absence of evidence of left atrial hypertension, and a significant risk of mortality.25

DIAGNOSIS
CLINICAL PRESENTATION
• History o The patient may be in present with complaints of acute dyspnea and suffocation o 'Can 't breathe ' is a short summation of complaints in the child that is exquisitely accurate o The patient may report paresthesia ( 'pins and needles sensation ') as a manifestation of hyperventilation; peri-oral paresthesia is typical o In some cases the patient may arrive in
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• Open lung biopsy in acute respiratory distress syndrome patients confirms the diagnosis of diffuse alveolar disease (DAD) typical of the condition 24
• lmmunocompromised hosts are especially susceptible to mortality from acute respiratory distress syndrome (e.g., children who have undergone stem cell transplant)29 9 11
• Low volume mechanical ventilation with positive end-expiratory pressure is primary therapy for acute respiratory distress syndrome 15
• Ventilatory-induced lung injury (VILI) from over-distension of the lung at high tidal volume constitutes the Foremost complication of acute respiratory distress syndrome treatment 15
• The prognosis is very worrisome with acute respiratory distress syndrome: as many as 50% of children diagnosed with this condition will die From it8
URGENT ACTION
• Acute presentation of acute respiratory distress syndrome in children (i.e., tachycardia, tachypnea, hypotention and shock) requires quick evaluation and initiation of a complex treatment plan involving hospitalist, intensivist, pulmonologist and pediatrician collaboratively rendering care that is in harmony with the goals of treatment (i.e., ventilation, oxygenation and

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