Corticoids and Respiratory Distress

PEDIATRICS ◽  
1973 ◽  
Vol 51 (5) ◽  
pp. 955-956
Author(s):  
William W. Holm
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Pulmonary Arteries ◽  
In Utero ◽  
Target Organ ◽  
Primary Target ◽  
Bronchial Arteries ◽  
Added Benefit

Liggins and Howie1 have demonstrated the effect of antepartum dexamethasone in the prevention of the respiratory distress syndrome (RDS). Contrary to the current concept2 that this prevention results from maturation of the lung, though this may be an added benefit, the writer proposes that the adrenal is the primary target organ. In a previous letter3 regarding the role of catecholamines in the etiology of RDS he advised that whereas the lung of the mature infant is perfused by the pulmonary arteries (inducing alveolar expansion),4 the lung of the infant in utero is perfused by the bronchial arteries (inducing atelectasis).4

The Respiratory Distress Syndrome: Bronchial Arteries and Catecholamines

PEDIATRICS ◽  
1972 ◽  
Vol 50 (6) ◽  
pp. 973-974
Author(s):  
William W. Holm
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Newborn Infant ◽  
Distress Syndrome ◽  
Ductus Arteriosus ◽  
Lung Parenchyma ◽  
In Utero ◽  
Pathological Findings ◽  
Bronchial Arteries ◽  
Intrapulmonary Shunting

Physiologically immature infants prone to the respiratory distress syndrome (RDS) have decreased endocrine reserve to cope with stresses of extrauterine life. Hormones beneficial in utero may possibly be detrimental to the newborn infant. Historically, the heart and lungs were considered separate entities; eventually the "heartlung" concept evolved. If we now consider the bronchial arteries and ductus arteriosus as a prenatal unit (with the former providing perfusion of the lung parenchyma) the "intrapulmonary shunting" and hypoperfusion found in RDS can be explained, and possibly the pathological findings of SIDS.

Role of Sildenafil in Management of Pediatric Acute Respiratory Distress Syndrome

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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