Pediatric acute lung injury. Paediatr Respir Rev

Medical Center of Coburg, Children's Hospital, Ketschendorferstr. 33, 96450 Coburg, Bayern, Germany.
Paediatric respiratory reviews (Impact Factor: 2.2). 01/2008; 8(4):348-62. DOI: 10.1016/j.prrv.2007.03.001
Source: PubMed


Among ventilated children, the incidence of acute lung injury (ALI) was 9%; of that latter group 80% developed the acute respiratory distress syndrome (ARDS). The population-based prevalence of pediatric ARDS was 5.5 cases/100.000 inhabitants. Underlying diseases in children were septic shock (34%), respiratory syncytial virus infections (16%), bacterial pneumonia (15%), near-drowning 9%, and others. Mortality ranged from 18% to 27% for ALI (including ALI-non ARDS and ARDS) and from 29% to 50% for ARDS. Mortality was only 3%-11% in children with ALI-non ARDS. As risk factors, oxygenation indices and multi-organ failure have been identified. New insights into the pathophysiology (for example the interplay between intraalveolar coagulation/fibrinolysis and inflammation and the genetic polymorphism for the angiotensin-converting enzyme) offer new therapeutic options. Lung protective mechanical ventilation with optimal lung recruitment is the mainstay of supportive therapy. New therapeutic modalities refer to corticosteroid and surfactant treatment. Well-designed follow up studies are needed.

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    • "Further the neonates who survive sepsis and septic shock continue to face substantial long term adverse effects [5]. Pediatric patients diagnosed with pneumonia or sepsis are also susceptible to acute lung injury or acute respiratory distress syndrome leading to a mortality rate of ∼25% [6], [7]. "
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    ABSTRACT: Probiotic use to prevent nosocomial gastrointestinal and potentially respiratory tract infections in critical care has shown great promise in recent clinical trials of adult and pediatric patients. Despite well-documented benefits of probiotic use in intestinal disorders, the potential for probiotic treatment to reduce lung injury following infection and shock has not been well explored. Evaluate if Lactobacillus rhamnosus GG (LGG) or Bifidobacterium longum (BL) treatment in a weanling mouse model of cecal ligation and puncture (CLP) peritonitis will protect against lung injury. 3 week-old FVB/N mice were orally gavaged with 200 µl of either LGG, BL or sterile water (vehicle) immediately prior to CLP. Mice were euthanized at 24 h. Lung injury was evaluated via histology and lung neutrophil infiltration was evaluated by myeloperoxidase (MPO) staining. mRNA levels of IL-6, TNF-α, MyD88, TLR-4, TLR-2, NFΚB (p50/p105) and Cox-2 in the lung analyzed via real-time PCR. TNF-α and IL-6 in lung was analyzed via ELISA. LGG and BL treatment significantly improved lung injury following experimental infection and sepsis and lung neutrophil infiltration was significantly lower than in untreated septic mice. Lung mRNA and protein levels of IL-6 and TNF-α and gene expression of Cox-2 were also significantly reduced in mice receiving LGG or BL treatment. Gene expression of TLR-2, MyD88 and NFΚB (p50/p105) was significantly increased in septic mice compared to shams and decreased in the lung of mice receiving LGG or BL while TLR-4 levels remained unchanged. Treatment with LGG and BL can reduce lung injury following experimental infection and sepsis and is associated with reduced lung inflammatory cell infiltrate and decreased markers of lung inflammatory response. Probiotic therapy may be a promising intervention to improve clinical lung injury following systemic infection and sepsis.
    Full-text · Article · May 2014 · PLoS ONE
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    • "Despite advances in intensive care unit policies, ALI and ARDS are still high risk conditions of pediatric intensive care unit admissions. Even in developed countries with high technically supported intensive care units, overall mortality rate ranges from 18% to 35% [1] [2] [3]. Acute phase of ALI/ARDS is characterized by increased permeability in the alveolocapillary membrane leading to interstitial and alveolar edema, accompanied by neutrophilic infiltration of alveolar spaces and production of proinflammatory cytokines, chemokines and reactive oxygen species [4]. "
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    ABSTRACT: Intravenous immunoglobulin (IVIG) therapy is used in inflammatory diseases but the use of immunoglobulin as a treatment for acute lung injury (ALI) has not been previously studied. Transforming growth factor beta (TGF-β) plays a critical role in the pathogenesis of of ALI. Therefore we examined the levels of TGF-β and lung inflammation scores in IVIG treated ALI models. Intratracheal lipopolysacccharide was given to rats. Groups 1 and 3 received saline, whereas group 2 received IVIG. 24h later saline was given to groups 1 and 2 and IVIG to group 3. Blood samples and bronchoalveolar lavage (BAL) fluids were obtained from each group and sacrificed for pathological evaluation. BAL TGF-β levels of groups 2 and 3 on day 30, were lower compared to their levels of day 2 (p=0.01, p=0.01). BAL TGF-β levels of groups 2 and 3 were lower than the levels of group 1 on day 30 (p=0.002, p=0.001). Pathological examination revealed that the inflammation scores of groups 2 and 3 on day 30, were lower than the scores of day 2 (p=0.02, p=0.01). Inflammation scores of group 2 were lower than group 1 on day 30 (p=0.02). Moderate fibrosis was seen in half of the rats from group 1 and one rat from group 2. High-dose IVIG decreased lung inflammation scores and BAL TGF-β1 levels and this therapy would give even better results if it is given earlier.
    Full-text · Article · Apr 2014 · International immunopharmacology
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    • "Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) have high morbidity and mortality inflicting a substantial burden on families and healthcare institutions [1] [2] [3]. ALI can be triggered by pulmonary insults like pneumonitis or systemic disease such as sepsis or trauma. "
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    ABSTRACT: Introduction. In the first 48 hours of ventilating patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), a multipronged approach including packed red blood cell (PRBC) transfusion is undertaken to maintain oxygen delivery. Hypothesis. We hypothesized children with ALI/ARDS transfused within 48 hours of initiating mechanical ventilation would have worse outcome. The course of 34 transfused patients was retrospectively compared to 45 nontransfused control patients admitted to the PICU at Helen DeVos Children's Hospital between January 1st 2008 and December 31st 2009. Results. Mean hemoglobin (Hb) prior to transfusion was 8.2 g/dl compared to 10.1 g/dl in control. P/F ratio decreased from 135.4 ± 7.5 to 116.5 ± 8.8 in transfused but increased from 148.0 ± 8.0 to 190.4 ± 17.8 (P < 0.001) in control. OI increased in the transfused from 11.7 ± 0.9 to 18.7 ± 1.6 but not in control. Ventilator days in the transfused were 15.6 ± 1.7 versus 9.5 ± 0.6 days in control (P < 0.001). There was a trend towards higher rates of MODS in transfused patients; 29.4% versus 17.7%, odds ratio 1.92, 95% CI; 0.6-5.6 Fisher exact P < 0.282. Conclusion. This study suggests that early transfusions of patients with ALI/ARDS were associated with increased ventilatory needs.
    Full-text · Article · Aug 2012 · Critical care research and practice
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