الفهرس 
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Abstract
Acute respiratory distress syndrome (ARDS) is a clinical syndrome of acute
respiratory failure following almost any severe physiologic insult that may or may
not have injured lungs primarily. The hallmark of the syndrome is increased
permeability of the alveolar capillary membrane, resulting in non-cardiogenic
pulmonary edema.
Acute lung injury follows a direct pulmonary or systemic insult resulting in
injury to the alveolar-capillary unit. Several diseases can cause ARDS, more
commonly following pneumonia, aspiration, and sepsis.
Several complications are associated with ARDS, though many of these are
due to the precipitating conditions that lead to ARDS. Acute complications include
air-leak syndromes, ventilator-induced lung infection (VILI), and multiple organ
dysfunction syndrome (MODS).
Ventilation is the cornerstone of treating the patient with ARDS.
Striking a balance between the level of ventilator support necessary to
provide a reasonable ventilation and oxygenation while minimizing VILI is one of
the most active areas of research in critical care.
The aim of this study is to study the differences in outcomes from
ALI/ARDS in children on mechanical ventilation using low versus conventional
tidal volumes.
This study is carried on 70 patients diagnosed with ALI/ARDS (aged 1
month to 16years) admitted to the Pediatric Intensive Care Unit (PICU) in Menoufia University hospital, in the period from November 2013 to December
2015 .
ALI /ARDS was diagnosed based on the 1994 American European
Consensus Criteria , The term “Acute Lung Injury” has been used as an umbrella
term for hypoxemic respiratory failure, a severe version of which is “Acute
Respiratory Distress Syndrome” (ARDS).
The characteristics are:
(1)Having acute onset
(2) Severe arterial hypoxemia (PaO2/FiO2 ≤200 torr) for ARDS and
<300 torr for acute lung injury (ALI)
(3)Bilateral radiographic infiltrates
(4) No evidence of left atrial hypertension.
We excluded patients with increased left atrial pressure.
All subjects included were submitted to:
Full history taking and thorough clinical examination
PRISM score were done to all patients.
Routine investigations, chest x ray and echocardiography were done.
All patients were mechanically ventilated with conventional ventilation
using pressure control mode( AC and SIMV with pressure support) .
Patients were subdivided into two groups : group 1: patients with ALI/ARDS receiving low tidal volume (6—8 ml/kg)
group 2 : patients with ALI/ARDS receiving conventional tidal volumes
(10–15 ml/kg).
Demographic data ،etiologies, and outcome data were recorded.
The most important outcome data were occurrence of barotrauma as
pneumothorax, mortality, occurrence of multiple organ system failure MOSF,
length of hospital stay and period of mechanical ventilation
Our results showed the precipitating factors for ARDS were:
Sepsis in 34.3% of group 1 and 42.9% of group 2, pneumonia in 28.6% of
group 1 and 31.4% of group2, aspiration in 20% of group 1 and 8.6% of group 2,
shock in 11.4% of group 1 and 8.6% of group 2, leukemia in 2.9% of group 1 and
5.7% of group 2, near drowning in 2.9% of group 1 and 2.9% of group 2.
The two groups of patients had a comparable oxygenation index OI , mean
OI in group 1 was 185.43 and in group 2 was 185.71 .also, they had a comparable
PRISM score where it was 21.75+1.49 in group 1 and 22.05 + 1.18 in group 2.
Mean age of patients of group 1 was 2.13 ±1.86 years, while in patients of
group 2, it was 1.92±1.12 years , and this difference was not statistically
significant.
In group 1 there were 17 males ( 48.6 %) and 18 females ( 51.4 %), while in
group 2 there were 20 males ( 57.1 %) and 15 females ( 42.9 %), there were no
statistically significant differences As regards barotrauma, incidence of pneumothorax was 5.7% in group 1
receiving low tidal volume versus 14.3% in group 2 receiving conventional tidal
volume and this difference was statistically significant .
There was a reduction in mortality rate in pediatric patients with ARDS
treated with low tidal volume (group 1) as it was 25.7% compared with patients
treated with conventional tidal volume (group 2) as it was 48.6% , and this
difference was statistically significant .
MODS was developed in 82.9% of patients of group 1 while in 88.6 % of
patients of group 2
MODS was identified as a risk factor for mortality , as it was present in 96%
of the died group versus 80 % in survived group . and patients in survived group
have more mods free days , it was 17.13±5.92 days versus 12.96 ±3.95 days in died
patients and and this difference was statistically significant.
Patients in group 1 who received lower tidal volume ventilation have more
days without MODS than patients in group 2 who received higher tidal volume , it
was 16.94±5.69 days in group 1 versus 14.34 ±5.36 days in group 2 and this
difference was statistically significant.
Duration of mechanical ventilation was a risk factor for mortality , it was
12.68±3.60 days in survived patients versus 19.84 ±6.85days in died patients , and
this difference was statistically significant.
Patients treated with lower tidal volume have lower duration of mechanical
ventilation , it was 11.22±2.26 days versus 19.25 ±5.98 days in patients treated
with conventional tidal volume,and this difference was statistically significant.Patients treated with lower tidal volume have lower duration of
hospitalization , it was 19.02±2.66 days versus 27.51 ±5.99 days in patients
treated with conventional tidal volume,and this difference was statistically
significant.
Duration of hospitalization was a risk factor for mortality , it was
20.36±4.27 days in survived patients versus 28.19 ±6.12 days in died patients , and
this difference was statistically significant.
In conclusion, lower tidal volume ventilation is associated with better
outcomes in patients with ALI/ARDS as it decreases incidence of barotrauma,
MOSF, mortality, duration of mechanical ventilation and duration of hospital stay.