1967, ARDS; initially an acronym that stood for Acute Respiratory Distress Syndrome, later to be known as Adult Respiratory Distress Syndrome. By 1994 till present-day, ARDS is officially known as Acute Respiratory Distress Syndrome. It is characterized by bilateral pulmonary infiltrates in the absence of left atrial hypertension with evidence of hypoxemia and poor lung compliance. Despite the many methods for the treatment and management of ARDS in pediatrics; positive pressure mechanical ventilation significantly helps to ensure adequate oxygenation with normal or close-to-normal PaCO2 and pH levels. On October 2010, an original research study from the National Institutes of Health ARDS Network (ARDSNet) published in CHEST journal was conducted to compare pressure characteristics of mechanical ventilation and their impact on the pediatric population with severe ARDS (from North Shore – Long Island Jewish Health System, Schneider Children’s Hospital) in the pre-protective lung strategy – 1992 to 1994 (pre-PLS) & 2000 to 2003 – post-PLS eras. They hypothesized that patients with severe ARDS in the previous era were exposed to much higher levels of positive inspiratory pressure (PIP), positive end-expiratory pressure (PEEP) & mean airway pressure (MAP), and for longer durations than in the post-PLS era, regardless of whether they received volume or pressure ventilation. In addition, the study hypothesized that the incidence of pneumothorax was to be significantly higher in the pre-PLS era, & that it was closely related to the pressure characteristics that these patients were exposed to. In this particular study, ARDSNet demonstrated that lower tidal volumes (TV) with low plateau pressures (Pplat) less than or equal to 30 cmH2O were associated with a better prognosis than if higher tidal volumes with higher plateau pressures greater than or equal to 50 cmH2O were issued. PLS aimed at preventing ventilation-induced lung injury (VILI) by delivering...
Cited: 1. Website (Journal): ORIGINAL RESEARCH - CRITICAL CARE MEDICINE:
a. Miller, Michael P and Sagy, Mayer. Pressure Characteristics of Mechanical Ventilation and Incidence of Pneumothorax Before and After the Implementation of Protective Lung Strategies in the Management of Pediatric Patients With Severe ARDS Chest November 2008 134:969-973; published ahead of print August 8, 2008, doi:10.1378/chest.08-0743
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