Acute Respiratory Distress Syndrome (ARDS)

Acute respiratory distress syndrome (ARDS) is frequently regarded as one of the most difficult patient populations for a clinician to handle, although accounting for a small proportion of all pediatric ICU patients. ARDS is a type of acute lung injury caused by a variety of pulmonary (direct lung injury) and extrapulmonary (indirect lung injury) causes. Pneumonia (35 percent), aspiration (15 percent), sepsis (13 percent), near-drowning (9 percent), concurrent heart failure (7 percent), and other clinical disorders were the predominant causes in a detailed description of juvenile ARDS (21 percent). Nearly half of these clinical disorders were caused by infectious causes, such as sepsis and pneumonia.

Pulmonary inflammation, alveolar edema, and hypoxic respiratory failure are all hallmarks of ARDS. Inflammatory, proliferative, and fibrotic stages describe the pathophysiology of this disease as it progresses. Since then, doctors treating newborns, kids, adolescents, and adults have faced diagnostic and therapeutic challenges. 

Multiple modifications of the ARDS definition for pediatric patients have been made over the years, including the Murray acute lung injury score, the American European Consensus Conference definition, the Delphi Consensus definition, and the Berlin definition. Although these diagnostic criteria were specifically designed for use in the adult population, they were frequently used in pediatric settings until lately. 

It's crucial to note that adult-based ARDS classifications may not apply to pediatrics for a number of reasons. Infants and children are more susceptible to severe respiratory injury than adults due to anatomical and physiological changes, which may need a lower intervention cut-off in the pediatric patient. Moreover, compared to teens and adults, younger patients have a higher metabolic requirement and less cardiac capacity. Considering the less widespread use of arterial lines in infants and children, earlier application of adult-based ARDS criteria to pediatrics, with the need to evaluate arterial oxygenation, may have resulted in an underestimating of the prevalence of ARDS in pediatrics. The inclusion of PaO2/FIO2, which can be altered by changes in applied mean airway pressure, as a signal of oxygenation failure is another ongoing problem of adult-based criteria to pediatric clinicians.