Clinical Spectrum of Acute Respiratory Distress Syndrome in a Tertiary Pediatric Intensive Care Unit

兒童加護中心的急性呼吸窘迫症候群病童之臨床表徵

王建得(Jiaan-Der Wang) ； 王德明(Teh-Ming Wang) ； 遲景上(Ching-Shiang Chi)

《Acta Paediatrica Taiwanica》 44卷4期 (2003/08) Pp. 202-207

https://doi.org/10.7097/APT.200308.0202

摘要

急性呼吸窘迫症候群在兒童重症醫療照護的領域是一個很大的挑戰。在台灣，兒童急性呼吸窘迫症候群的臨床現象很少被報告。本研究目的在評估兒童加護中心急性呼吸窘迫症候群的發生率，促成因子，臨床表現，呼吸器使用的技巧，輔助性治療和預後。以回顧性的研究檢視過去三年本院兒童加護中心住院病童地，顯示有十六位符合急性呼吸窘迫症候群診斷標准及廣義性Murray等人的定義。發生率佔所有中護中心入院的0.2%。促成因子呈現多變性，肺炎是最常見因子。急性肺傷害分數，呼吸指數和氣合指數的平均值分別是3.6±0.5，68.0±32.8和71.6±25.2。最大吸氣尖峰壓力和吐氣未正壓的平均值分別是40.3±9.8和14.0±4.6cmH2O。有三位(19%)病童死亡。與十年前高死亡率(82%)比較，我們強調溫和的呼吸器使用、及早應用高吐氣正末壓、使用sodium nitroprusside噴霧吸入或nitric oxide吸入輔助療法可得到較高的存活率。

關鍵字

急性呼吸窘迫症候群 ； 吐氣末正壓 ； sodium nitroprusside噴霧吸入 ； 吸入性nitric oxide

並列摘要

Acute respiratory distress syndrome (ARDS) has been a great challenge in the field of pediatric critical care medicine. The clinical picture of children with ARDS in Taiwan has seldom been reported. The purpose of this study was to investigate the incidence, predisposing factors, clinical manifestations, strategies of ventilator support, adjuvant therapies, and prognosis of children with ARDS in a tertiary pediatric intensive care unit (PICU). A retrospective review of admissions to our PICU in the past 3 years showed that 16 cases met the criteria of pediatric ARDS. The incidence was 0.2% of all PICU admissions. The predisposing factors were varied, and pneumonia was the most common. The mean values of acute lung injury scores, ventilation indices and PaO/Fi02 on admission were 3.6±0.5, 68.0±32.8 and 71.6±25.2, respectively. The averages of maximal peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP) were 40.3±9.8 and 14.0±4.6 cmH2O, respectively. Only three patients (19%) expired due to overwhelming systemic infection. Compared with our previous high mortality rate report, we emphasized gentle mechanical ventilation care, early employment of high PEEP and adjuvant therapy with sodium nitroprusside (SNP) nebulization and/or inhaled nitric oxide (iNO) to achieve an improved survival rate.

並列關鍵字

acute respiratory distress syndrome ； positive end-expiratory pressure ； sodium nitroprusside nebulization ； inhaled nitric oxide