Acute respiratory distress syndrome

This chapter will review the targets for ultrasound assessment, including biventricular function, extravascular water, and systemic volume assessment. Importantly, it will discuss how to differentiate cardiogenic from non-cardiogenic pulmonary oedema, how to recognize acute cor pulmonale, and when to look for a patent foramen ovale. The advanced section will introduce Doppler-based methods to evaluate right ventricular systolic function and pulmonary arterial systolic pressure, which can both become compromised in acute respiratory distress syndrome.

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Role of Sildenafil in Management of Pediatric Acute Respiratory Distress Syndrome

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1730900 ◽

2021 ◽

Author(s):

Monika Janagill ◽

Puneet Aulakh Pooni ◽

Siddharth Bhargava ◽

Shibba Takkar Chhabra

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Pediatric Intensive Care ◽

Inclusion Criteria ◽

Northern India ◽

Pulmonary Vasodilator ◽

Pulmonary Arterial

AbstractAcute respiratory distress syndrome (ARDS) has high mortality and multiple therapeutic strategies have been used to improve the outcome. Inhaled nitric oxide (INO), a pulmonary vasodilator, is used to improve oxygenation. This study was conducted to determine the role of sildenafil, an oral vasodilator, to improve oxygenation and mortality in pediatric ARDS (PARDS). The prevalence of pulmonary hypertension in PARDS was studied as well. Inclusion criteria included children (1–18 years) with ARDS requiring invasive ventilation admitted to the pediatric intensive care unit of a teaching hospital in Northern India over a 1-year period of time. Thirty-five patients met the inclusion criteria. Cardiologist performed a detailed echocardiogram to determine pulmonary arterial pressure (PAP). Patients with persistent hypoxemia were started on oral sildenafil. The majority (77%) patients had a primary pulmonary etiology of PARDS. Elevated PAP (>25 mm Hg) was detected in 54.3% patients at admission. Sildenafil was given to 20 patients who had severe and persistent hypoxemia. Oxygenation improved in most patients after the first dose with statistically significant improvement in PaO2/FiO2 ratios at both 12 and 24 hours following initiation of therapeutic dosing of sildenafil. Improvement in oxygenation occurred irrespective of initial PAP. Outcomes included a total of 57.1% patients discharged, 28.6% discharged against medical advice (DAMA), and a 14.3% mortality rate. Mortality was related to the severity of PARDS and not the use of sildenafil. This is the first study to determine the effect of sildenafil in PARDS. Sildenafil led to improvement in oxygenation in nearly all the cases without affecting mortality. Due to unavailability of INO in most centers of developing countries, sildenafil may be considered as an inexpensive alternative in cases of persistent hypoxemia in PARDS. We recommend additional randomized controlled trials to confirm the effect of sildenafil in PARDS as determined in this study.

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