The outcome of acute respiratory distress syndrome in children treated by lung protective ventilation strategy

Objective To observe the effect of lung protective ventilation on children with acute respiratory distress syndrome primarily from pulmonary diseases(ARDSp)and acute respiratory distress syndrome primarily from extra-pulmonary diseases(ARDSexp). Methods Between January 2003 and December 2014, 354 children with ARDS admitted in PICU of Shengjing Hospital of China Medical University were enrolled and devided into ARDSp protective-ventilation group(n=154), ARDSp conventional-ventilation group(n=96), ARDSexp protective-ventilation group(n=72)and ARDSexp conventional-ventilation group(n=32). The patients in ARDSp protective-ventilation group and ARDSexp protective-ventilation group received lower tidal volume(6-8 ml/kg) and high levels of positive end-expiratory pressure(PEEP), and optimal oxygenation was achieved by adjusting FiO2 and PEEP.The patients in ARDSp conventional-ventilation group and ARDSexp conventional-ventilation group received relatively higher tidal volume(10-12 ml/kg), and optimal oxygenation was achieved by adjusting FiO2 and PEEP.The mortality, ventilator days and PICU stay days were compared among the four groups. Results The mortality, ventilation days, and PICU stay days were lower in ARDSp protective-ventilation group than those of ARDSp conventional-ventilation group[35.29% vs.45.62%, 12(2-44)d vs.16(3-26)d, 16(2-67)d vs.22(3-56)d], but there were no significant differences(P>0.05). The mortality, ventilation days, and PICU stay days were also lower in ARDSexp protective-ventilation group than those of conventional-ventilation group[22.22% vs.46.87%, 9(1-19)d vs.16(1-21)d, 14(1-66)d vs.25(1-47)d], which showed significant differences(P<0.05). Conclusion Lung protective ventilation may improve the outcome for pediatric patients with ARDSexp, however, larger trials are required before a definite conclusion can be reached. Key words: Acute respiratory distress syndrome; Lung protective ventilation