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Jan.14.2021
 Acute Respiratory Distress Syndrome, Pediatric

Acute Respiratory Distress Syndrome, Pediatric

Acute respiratory distress syndrome (ARDS) is a life-threatening condition. The lungs become swollen and blood vessels leak fluid into the air sacs (alveoli). This prevents the lungs from working well. It also makes it hard to get oxygen into the blood. This can damage other vital organs, such as the heart, kidneys, liver, or brain. Your child will need intensive care in a hospital.

What are the causes?

The condition usually develops in response to a major illness, surgery, injury, or widespread infection (sepsis).
It may be caused by:
  • An infection in the blood or lungs.
  • A serious injury to the chest.
  • A serious injury that causes low blood pressure.
  • A major surgery.
  • Breathing in smoke, water, or harmful chemicals.
  • Blood transfusions.
  • Breathing in vomit (aspiration).
  • Inflammation of the pancreas (pancreatitis).

What are the signs or symptoms?

The main symptoms of this condition are sudden shortness of breath and rapid shallow breathing. Other symptoms may include:
  • A fast or irregular heart rate.
  • Crackles in lungs.
  • Skin, lips, or fingernails that appear blue (cyanosis).
  • Grunting or flaring of the nostrils when breathing.
  • Tiredness or loss of energy.
  • Chest pain, particularly when taking a breath.
  • Coughing.
  • Restlessness or anxiety.
  • Fever. This is usually present if there is an underlying infection, such as pneumonia.

How is this diagnosed?

This condition is diagnosed based on:
  • Medical history, including your child's symptoms.
  • Physical exam.
Your child may also have other tests, including:
  • A test that measures the percentage of oxygen in your child's blood (pulse oximetry). This is done with a sensor that is placed on your child's finger, toe, or earlobe.
  • Blood tests.
  • Chest X-rays or CT scans to look for fluid in the lungs.
Your child may also have other tests to rule out other conditions, including:
  • Taking a sample of your child's sputum to test for infection.
  • Heart tests, such as an echocardiogram or electrocardiogram. These tests check heart function and blood flow in the heart.
  • Taking a sample of your child's urine to test for infection or kidney problems.
  • Bronchoscopy. During this test, a thin, flexible tube with a light is passed into the mouth or nose, down the windpipe, and into the lungs.

How is this treated?

The treatment goal is to support your child while the lungs heal and the underlying cause is treated. Treatment may include:
  • Oxygen therapy.
  • Noninvasive ventilation: A device such as a continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BPAP) machine may be used to help your child breathe. The device gives your child oxygen and pressure through a mask or helmet.
  • Positioning your child to lie on his or her stomach (prone position).
  • A breathing machine (ventilator) may be used to help your child breathe. This device gives oxygen and pressure through a tube that is put through your child's mouth into the windpipe (trachea).
    • If this treatment is needed longer term, a tracheostomy may be placed. A tracheostomy is a breathing tube put through your child's neck directly into the windpipe (trachea).
  • Fluid and medicine is given through an IV.
  • Medicines may be given to:
    • Help your child relax (sedatives).
    • Treat blood pressure.
    • Treat infection.
    • Prevent blood clots (anticoagulants).
    • Help get rid of excess fluid (diuretics).
  • In severe cases, extracorporeal life support (ECLS) may be used. This treatment temporarily takes over the function of the heart and lungs, supplying oxygen and removing carbon dioxide. ECLS gives the lungs a chance to rest and recover.

Follow these instructions at home:

Medicines

  • Give your child over-the-counter and prescription medicines only as told by your child's health care provider.
  • Do not give your child aspirin because of the association with Reye's syndrome.
  • If your child was prescribed an antibiotic medicine, give it to your child as told by the health care provider. Do not stop giving the antibiotic even if your child starts to feel better.
  • If your child is taking blood thinners:
    • Talk with your child's health care provider before you give any medicines that contain aspirin or NSAIDs, such as ibuprofen. These medicines increase the risk for dangerous bleeding.
    • Give medicine exactly as told, at the same time every day.
    • Help your child to avoid activities that could cause injury or bruising. Follow instructions about how to prevent falls.
    • Have your child wear a medical alert bracelet or carry a card that lists what medicines her or she takes.

Lifestyle

  • Do not allow your child to use any products that contain nicotine or tobacco, such as cigarettes, e-cigarettes, and chewing tobacco. Do not allow your child to be around other people that smoke (secondhand smoke). If you or your child need help quitting, ask your health care provider.
  • Have your child rest and return to his or her normal activities as told by his or her health care provider. Ask your child's health care provider what activities are safe for your child.
  • It may take a while for your child to get back to his or her normal activities and routine.
    • Your child may need help doing normal activities.
    • Your child may need physical therapy. This can help with muscle weakness and shortness of breath.
    • Your child may be depressed, anxious or have trouble with memory and concentration. Talk to your child's health care provider about ways to help your child feel better.

General instructions

  • Have your child wear compression stockings as told by the health care provider. These stockings help to prevent blood clots and reduce swelling in the legs.
  • Keep all follow-up visits as told by your child's health care provider. This is important.

Where to find more information

Contact a health care provider if:

  • Your child becomes short of breath during activity or while resting.
  • Your child develops a cough that does not go away.
  • Your child has a fever.
  • Your child's symptoms do not improve or they get worse.
  • Your child becomes anxious or depressed.

Get help right away if:

  • Your child who is younger than 3 months has a temperature of 100.4°F (38°C) or higher.
  • Your child has trouble breathing.
  • Your child develops sudden chest pain that does not go away.
  • Your child has a rapid heart rate.
  • Your child develops swelling or pain in one of his or her legs.
  • Your child coughs up blood.
  • Your child has trouble breathing.
  • Your child's skin, lips, or fingernails turn blue.
These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.).

Summary

  • Acute respiratory distress syndrome is a life-threatening condition in which fluid collects in the lungs. This can cause the lungs and other vital organs to fail.
  • The condition usually develops following a major illness, surgery, injury or widespread infection (sepsis).
  • If your child was prescribed an antibiotic medicine, give it to your child as told by the health care provider. Do not stop giving the antibiotic even if your child starts to feel better.
  • Do not allow your child to be around other people that smoke (secondhand smoke).

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.

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