Distress Respiratorio Agudo en el niño. Nuestras experiencias de 5 años.5
Coincidimos con el estudio del Dr, D. McAuley, en Irlanda, el cual también encontró que los niveles más bajos de PaO2/FiO2 estaban relacionados con una mayor mortalidad. (30) Recientemente en España, el Dr. J. Villar y colaboradores (2007) relacionaron el estado de oxigenación y la mortalidad con resultados similares a los nuestros, o sea, mayor mortalidad en aquellos con relación PaO2/FiO2 más bajas. (35)
En nuestro estudio podemos concluir que la incidencia del Síndrome de Distress Respiratorio Agudo en el niño ha disminuido durante el período estudiado, siendo de 4,2 x 100.000 habitantes en los cinco años, predominó el Síndrome de Distress Respiratorio Agudo (SDRA) Pulmonar con una sobrevida menor en relación al Extrapulmonar, las causas fundamentales del Síndrome de Distress Respiratorio Agudo (SDRA) fueron la neumonía, politraumatismos y la sepsis, las complicaciones más frecuentemente encontradas fueron los trastornos hemodinámicos y la sepsis nosocomial, los pacientes con Síndrome de Distress Respiratorio Agudo (SDRA) tuvieron una larga estadía en la ventilación mecánica, los cuales se relacionaron con niveles bajos de PaO2/FiO2. Por último concluimos que el índice de mortalidad también estuvo directamente relacionado con los niveles de PaO2/FiO2 más bajos.
Referencias.
1. Liu KD, Matthay MA. Advances in Critical Care for the Nephrologist: Acute Lung Injury/ARDS.Clin J Am Soc Nephrol. 2008 Jan 16.
2. Gattinoni L, Caironi P, Carlessco E. How to ventilate patients with acute lung injury and acute respiratory distress syndrome. Curr Opin Crit Care. 2005 Feb; 11(1):69-76.
3. Sevransky JE, Levy MM, Marini JJ. Mechanical ventilation in sepsis-induced acute lung injury/acute respiratory distress syndrome: an evidence-based review. Crit Care Med. 2004 Nov;32(11 Suppl):S548-53.
4. Larsson A, Blomqvist H, Frostell C, Lindén V, Sjostrand U, Walther SM. Ventilation in ARDS: respirator, prone position, NO or artificial lung. Lakartidningen.2000 Apr 26;97(17):2058-63.
5. Fan E, Needham DM, Stewart TE. Ventilatory management of acute lung injury and acute respiratory distress syndrome. JAMA. 2005 Dec 14; 294(22):2889-96.
6. Kuhlen R, Dembinski R Mechanical ventilation of acute lung injury. Pneumology. 2007 Apr; 61(4):249-55.
7. Mehta NM,Arnold JH. Mechanical ventilation in children with acute respiratory failure. Curr Opin Crit Care. 2004 Feb;10(1):7-12.
8. Oczenski W, Scharz S, Fitzgerald RD. Clinical impact of recruitment maneuvers in patients with acute respiratory distress syndrome. Anasthesiol Intensivmed Notfallmed Schmerzther. 2004 Aug;39(8):463-70.
9. Dupont H, Mentec H, Cheval C, Moine P, Fierobe L, Timsic JF. Short-term effect of inhaled nitric oxide and prone positioning on gas exchange in patients with severe acute respiratory distress syndrome. Crit Care Med. 2000 Feb;28(2):304-8.
10. Antonio Articas, Gordon R. Bernard, Jean Carlet, Didier Dreyfuss, Luciano Caitinoni,
Leonard Hudson, Maurice Lamy, John J. Marini, Michael A. Matthay, Michael R. Pinsky. The American-European Consensus Conference on ARDS. Am J Respir Crit Care Med. 1998; 157: 1332-l 347.
11. Dhanireddy S, Altemeier WA, Matute Bello G, Oª Mahony DS, Glenny RW, Martin TR, Liles WC. Mechanical ventilation induces inflammation, lung injury, and extra-pulmonary organ dysfunction in experimental pneumonia.Lab Invest. 2006 Aug;86(8):790-9.
12. Medina Villanueva JA, Menendez Cuervo S, Rey Galan C, Concha Torre JA. Ventilation in special situations. Mechanical ventilation in acute respiratory distress syndrome/acute pulmonary lesion. An Pediatr ( Barc ) 2003 Oct;59(4):366-72.
13. Jolliet P, Bulpa P, Ritz M, Ricou B, Lopez J, Chevrolet JC. Additive beneficial effects of the prone position, nitric oxide, and almitrine bismesylate on gas exchange and oxygen transport in acute respiratory distress syndrome. Crit Care Med. 1997 May; 25(5):786-94.
14. Kopp R, Kuhlen R, Max M, Rossaint R. Evidence-based medicine in the therapy of the acute respiratory distress syndrome. Intensive Care Med. 2002 Mar; 28(3):244-55.
15. Girard TD, Ware LB. Biomarkers of cardiac injury in acute respiratory distress syndrome: getting to the heart of the matter. Crit Care Med. 2007 Nov;35(11):2638-9.
16. Kim SJ, Oh BJ, Lee JS, Lim CM, Shim TS, Lee SD, Kim WS, Kim DS, Kim WD, Koh Y. Recovery from lung injury in survivors of acute respiratory distress syndrome: difference between pulmonary and extrapulmonary subtypes. Intensive Care Med. 2004 Oct;30(10):1960-3.
17. Pelosi P, D'Onofrio D, Chiumello D, Paolo S, Chiara G, Capelozzi VL, Barbas CS, Chiaranda M, Gattinoni L. Pulmonary and extrapulmonary acute respiratory distress syndrome are different. Eur Respir J Suppl. 2003 Aug;42:48s-56s.
18. Callister MF, Evans TW. Pulmonary versus extrapulmonary acute respiratory distress syndrome: different diseases or just a useful concept? Curr Opin Crit Care. 2002 Feb;8(1):21-5.
19. Pelosi P, Caironi P, Gattinoni L. Pulmonary and extrapulmonary forms of acute respiratory distress syndrome. Semin Respir Crit Care Med. 2001 Jun; 22(3):259-68.
20. Dahlem P, Van Aalderen WM, Bos AP. Pediatric acute lung injury.Paediatr Respir Rev. 2007 Dec;8(4):348-62.
21. Luhr OR, Antonsen K, Karlsson M, Aardal S, Thorsteinsson A, Frostell CG, Bonde J. Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF Study Group. Am J Respir Crit Care Med. 1999 Jun; 159(6):1849-61.
22. Frutos-Vivar F, Nin N, Esteban A. Epidemiology of acute lung injury and acute respiratory distress syndrome. Curr Opin Crit Care. 2004 Feb;10(1):1-6.
23. Kneyber MC, Brouwers AG, Caris JA, Chedamni S, Plötz FB. Acute respiratory distress syndrome: is it underrecognized in the pediatric intensive care unit?. Intensive Care Med. 2008 Apr; 34(4):751-4.
24. Estenssoro E, Dubin A, Laffaire E, Canales HS, Sáenz G, Moseinco M, Bachetti P. Impact of positive end-expiratory pressure on the definition of acute respiratory distress syndrome. Intensive Care Med. 2003 Nov;29(11):1936-42.
25. Agarwal R, Aggarwal AN, Gupta D, Behera D, Jindal SK. Etiology and outcomes of pulmonary and extrapulmonary acute lung injury/ARDS in a respiratory ICU in North India.Chest. 2006 Sep;130(3):724-9.
26. Norrashidah AW, Azizi BH, Zulfiqar MA. Acute respiratory distress syndrome in a paediatric intensive care unit. Med J Malaysia. 1999 Jun;54(2):225-9.
27. Lu Y, Song Z, Zhou X, Huang S, Zhu D, Yang C Bai X, Sun B, Spragg R; Shanghai ARDS Study Group. A 12-month clinical survey of incidence and outcome of acute respiratory distress syndrome in Shanghai intensive care units. Intensive Care Med. 2004 Dec;30(12):2197-203.
28. McAuley D; The Irish Critical Care Trials Group. Acute lung injury and the acute respiratory distress syndrome in Ireland: a prospective audit of epidemiology and management. Crit Care. 2008 Feb 29; 12(1):R30
29. Treggiari MM, Hudson LD, Martin DP, Weiss NS, Caldwell E, Rubenfeld G. Effect of acute lung injury and acute respiratory distress syndrome on outcome in critically ill trauma patients. Crit Care Med. 2004 Feb;32(2):327-31
30. Lee TW, Kwek TK, Tai D, Earnest A, Loo S, Singh K, Kwan KM, Chan Y, Yim CF, Bek SL, Kor AC, Yap WS, Chelliah YR, Lai YC, Goh SK. Acute respiratory distress syndrome in critically ill patients with severe acute respiratory syndrome. JAMA. 2003 Jul 16;290(3):374-80.
31. Fialkow L, Vieira SR, Fernandes AK, Silva DR, Bozzetti MC; Acute Respiratory Distress Syndrome Research Group. Acute lung injury and acute respiratory distress syndrome at the intensive care unit of a general university hospital in Brazil. An epidemiological study using the American-European Consensus Criteria. Intensive Care Med. 2002 Nov;28(11):1644-8.
32. Samransamruajkit R, Jitchaiwat S, Deerojanawong J, Sritippayawan S, Praphal N. Adrenal insufficiency in early phase of pediatric acute lung injury/acute respiratory distress syndrome. J Crit Care. 2007 Dec; 22(4):314-8.
33. Brun-Buisson C, Minelli C, Bertolini G, Brazzi L, Pimentel J, Lewandowski K, Bion J, Romand JA, Villar J, Thorsteinsson A, Damas P, Armaganidis A, Lemaire F; ALIVE Study Group. Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study. Intensive Care Med. 2004 Jan; 30(1):51-61.
34. Dahlem P, van Aalderen WM, Hamaker ME, Dijkgraaf MG, Bos AP.
Incidence and short-term outcome of acute lung injury in mechanically ventilated children. Eur Respir J. 2003 Dec; 22(6):980-5.
35. Villar J, Pérez-Méndez L, López J, Belda J, Blanco J, Saralegui I, Suárez-Sipmann F, López J, Lubillo S, Kacmarek RM; HELP Network. An early PEEP/FIO2 trial identifies different degrees of lung injury in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2007 Oct 15; 176(8):795-804.