الفهرس 
cute Respiratory Distress Syndrome (ARDS)Only 14 pages are availabe for public view
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Abstract
The acute respiratory distress syndrome (ARDS) is an important cause of acute respiratory failure that is often associated with multiple organ failure. Several clinical disorders can precipitate ARDS, including pneumonia, sepsis, aspiration of gastric contents, and major trauma. Physiologically, ARDS is characterized by increased permeability pulmonary edema, severe arterial hypoxemia, and impaired carbon dioxide excretion.
A clinically significant increase in lung water is a frequent condition in intensive care patients and is usually secondary to acute heart failure, acute lung injury or acute respiratory distress syndrome (ARDS)
A quantitative measurement of extravascular lung water (EVLW) would be extremely useful for the clinical management of these conditions, both as an index of severity and to guide treatment
Historically, the most frequently used examination for this purpose in the clinical arena has been chest radiography, which may also allow semiquantitative assessment of pulmonary edema using a specific scoring systems.
Unfortunately, portable chest radiography in the critical care setting often yields inaccurate images.
The gold standard for noninvasive EVLW assessment is represented by quantitative computed tomography (CT), which unfortunately is both expensive and often not feasible, since it requires the transfer of a critical patient to the radiology department; moreover, it employs ionizing radiation
In recent years, lung ultrasonography (LUS) has been proposed as a versatile tool for the assessment of some pulmonary and pleural diseases.
The present study is a prospective observational cohort study conducted on 35 children with ARDs. The aim of study was to evaluate the prognostic value of extravascular lung water assessed with lung ultrasound score in patients admitted to PICU.
The demographic data of the study showed that the patients were 23 female, 12 male with age ranged from 1.2 to 120 months, range of weight was 6 to 40 kgs, mean HR was 146.79 ± 20.77 b/m, mean RR was 53.21 ± 15.69 cycle/min, mean temperature was 38.17 ± 0.87 C and mean Systolic blood pressure was 73.58 ± 14.08 mmHg and mean Diastolic 44.18 ± 10.52mmHg, the mean of initial ABGs were (PH 7.13 ± 0.14, Co2 79.82 ± 14.31, Pao252.33 ± 17.45, HCO319.93 ± 4.02) and the mean of P/F ratio was 149.69 ± 88.96, 34.3% of patients had complications, 14.3% had pneumothorax, 40% had sepsis, and 8.6% had DIC and mortality was 40%, 31.4%of patients had mild lung injury, 34.3% had moderate lung injury, same percent with severe lung injury (34.3%)
Patients are divided in to two groups according to the outcome in to survivors group (n= 21) and non- survivors (n= 14) there was statistical difference between both groups regarding vital data in day 1 and 3 as regards heart rate, respiratory rate in day 3 and systolic blood pressure in day 1, while all the ABG parameters showed highly significant differences between both groups.
Fifteen of patients were on conventional mode of ventilation (mean PIP, PEEP, rate, FIO2 =24.88 ± 12.14, 9.64 ± 3.35, 42.4 ± 40.1, 52.5±49.3 respectively), 3 patients were on HFO mode (mean Delta B, FIO2, rate = 40±12.3, 52.5±49.3, 10.36±9.73 respectively) while 10 were on HFO and changed to conventional and 7 were on conventional and changed to HFO mode with no significant difference between both groups, also no difference regarding days on PICU nor days on MV affected by modes of vent but significant difference was noted as regards SOFA score and PF ratio.
The mean lung ultrasound score was 19.83 ± 9.21 which was statistically significant between survivors and non survivors groups and the results of AUC of lung ultrasound score at cut off point (>27) showed statistical significant with outcomes with 100% sensitivity and 100% specificity.
Significant correlations were found between items of ABG and lung ultrasound score, but no correlations found regarding stay in PICU, days on MV.