Text: Chen Qiulei Organizer: Liang Yingxiu
Acute respiratory distress syndrome in children is caused by direct or indirect infection and damage to the lungs, and severe cases can be fatal.
The mortality rate in high-income countries is about 30%, and it is as high as 75% in low-income countries. The symptoms are similar to respiratory infections;
(KUALA LUMPUR) Pediatric Acute Respiratory Distress Syndrome (PARDS) is a clinical syndrome caused by acute lung injury, which makes blood oxygen levels difficult to maintain.
Because the inflammation mainly occurs in the lungs, the exchange of oxygen and carbon dioxide cannot be carried out as usual, the blood oxygen level drops, and the oxygen tissue is eventually destroyed, which leads to the decline of organ function and cannot function normally.
Premature Babies Susceptible to PARDS
What exactly causes PARDS? Dr. Tai Chian Wern, a specialist consultant in pediatric intensive care medicine, pointed out that it is a disease caused by direct or indirect damage to the lungs. The most common and direct cause is pneumonia or respiratory tract infection, which may be caused by bacteria, germs and fungi.
“Other causes include aspiration pneumonia (such as when a baby chokes on milk while breastfeeding), drowning, and inhalation injuries, such as inhaling toxic fumes such as fire fumes and chemicals.”
He said that the first reason for suffering from PARDS is that some children need blood transfusion due to some medical reasons, and the blood transfused into the body does not belong to him. He rejects it, and there are adverse reactions during the blood transfusion process, which leads to PARDS.
Blood tests are usually done before transfusion to make sure the patient is suitable. However, in rare cases, the above situation can still occur.
The second most common cause, sepsis, is an indirect cause, which is a severe bloodstream infection. In some children, the body becomes inflamed from sepsis, which can also trigger PARDS.
Children with congenital heart disease, immunocompromised conditions (such as those with cancer undergoing chemotherapy), and comorbidities such as chronic lung disease are more likely than ordinary children to develop PARDS.
He also said that premature babies are born before full term, their bodies are weak, their organs have not yet developed, and they use ventilators for a long time in the newborn stage, causing lung damage. Therefore, they are also prone to PARDS.
Underdiagnosis of PARDS in my country
According to one of the most extensive international studies ever-
Incidence and epidemiology of acute respiratory distress syndrome in children in 2019
(Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology, PARDIE) pointed out,
PARDS accounts for 3% of pediatric intensive care unit admissions worldwide,
About 6% of pediatric patients require respirators.
Most of the participants in this study were high-income countries.
However, the data on PARDS in my country is quite poor. Due to the late onset of patients in this region and the vast geographical area, the problem of underdiagnosis of PARDS often occurs.
Between 2019 and 2022, 21 pediatric and critical care specialists from 9 high-income to low-income countries participated in a study led by the Pediatric Acute and Critical Care Medical Asian Network (PACCMAN). , mainly for the research of PARDS.
Dai Jianwen is also one of them, “We are still analyzing relevant information and data, and hope that the results of this study will be released to the world by the end of this year.”
Mostly caused by lung infection children than adultsdeteriorationquick
Symptoms of PARDS are usually on the airways and include shortness of breath, difficulty breathing, coughing, and often a drowsy state due to low oxygen levels.
It is mostly caused by a lung infection, and patients may also experience fever and difficulty eating.
Dai Jianwen pointed out that it must be noted that children are different from adults, and their deterioration rate is faster than adults. If the onset is too late, a child with severe PARDS may be unconscious and not breathing.
Find symptoms and detect blood oxygen
“From the above symptoms, the symptoms of PARDS seem to be the same as those of general respiratory infection diseases, but the symptoms of this disease are actually closer to those of pneumonia, such as fever, dyspnea, cough, and at the same time, the usually active child becomes quiet. , Not eating or drinking, not feeling well, and the test found that the blood oxygen level is lower than normal, then you should be sent to the doctor immediately.”
When it comes to the detection of blood oxygen levels, I believe that many people know more or less about the relevant knowledge during the COVID-19 invasion of the world. Similarly, if the above symptoms are found, we can first use a pulse oximeter to detect blood oxygen to get a preliminary grasp of the level.
However, using a home-use pulse oximeter alone is not enough to diagnose the result, so parents still need to take their children to the hospital for a more accurate blood oxygen test with a medical-grade pulse oximeter.
Before 2015, the definition of PARDS has always been based on adult standards.
“Until 2015, the Pediatric Acute Lung Injury Consensus Conference (PALICC) issued a guideline for only pediatric criteria.”
He said that the diagnosis of PARDS mainly uses PALICC criteria. We know that the biggest symptom of PARDS is hypoxic respiratory failure, which means that the lungs cannot provide enough oxygen to the body tissues, which can be detected through arterial blood oxygen analysis.
According to the above-mentioned newly issued guidelines, there are several key points in the diagnostic criteria, such as acute lung injury occurring within 7 days; arterial blood oxygen decline; and the results of lung X-ray.
ECMO provides oxygen but the cost is high
He revealed that almost all patients suffering from PARDS need invasive or non-invasive ventilator treatment and support.
Patients with mild illness have difficulty breathing and can use non-invasive breathing equipment. The patient wears an oxygen mask and is assisted by a respirator to breathe.
Most moderately or severely ill patients require invasive respiratory rescue because they cannot breathe. The doctor first performs general anesthesia, and puts a catheter into the trachea to deliver oxygen to the patient. This treatment method is equivalent to “replacing” the breathing work of the human body by a ventilator.
According to most studies, the above-mentioned medical treatment lasts about 10 days on average, but it still depends on the severity of the disease.
In addition to invasive ventilator, a severely ill patient may also require treatment of other organs, such as kidney dialysis, depending on the severity and the condition of the organs involved.
“In high-income countries, doctors prescribe extra-corporeal membrane oxygenation (ECMO) to children with severe PARDS. This is a medical device that takes over the function of the heart and lungs, allowing the lungs to rest Provide enough oxygen to all parts of the body while recovering.”
“Unfortunately, the ECMO medical project requires a group of professional teams to provide full medical support, coupled with the high cost, only a few medical centers in my country provide this medical facility. Therefore, most medical units in my country do not include it in the treatment option.”
PARDS leads to hypoxemia. Long-term hypoxemia will affect the function of organs, such as kidneys, liver, brain and heart. Without early intervention and treatment, organs that are extremely important for maintaining life will stop functioning.
When this happens, death may follow.
As stated above, PARDS is a fatal condition. Severe PARDS has a mortality rate of approximately 30% in high-income countries and as high as 75% in low-income countries. Why is the gap so far? This is primarily a result of disparities in resource availability, socioeconomic conditions and manifestations, late manifestations of the disease, and management strategies.
ECMO is not popular in my country
“One thing we can’t ignore is that PARDS may affect developing children, such as decreased kidney function and affected brain intelligence development.” With the availability of ECMO medical equipment, the survival rate of critically ill patients has greatly improved. However, this is not common in low- and middle-income countries, including my country.
PARDS may recur after recovery if the child is re-exposed to the causative agent.
The most common causes of PARDS are infection, pneumonia, and sepsis. Therefore, doctors must prevent these infectious diseases, so as to most effectively reduce the risk and probability of suffering from PARDS.
Influenza vaccination is encouraged
He has a few suggestions for parents:
1.Keep children up to date on their vaccinations, including encouraging parents to get an annual flu shot;
2.Teach your child good personal hygiene, such as washing hands frequently;
3.Be considerate of others and wear a mask when in public if you are unwell;
4.If your child is unwell, it is important to seek medical attention as soon as possible.
Dai Jianwen reminded parents that if PARDS is diagnosed early, treatment can be started to prevent the disease from developing into a severe disease. The final result is beneficial to the disease; although PARDS is an uncommon disease, it may be life-threatening. “It is important to seek medical attention early to avoid complications and worsening of the condition.”