Acute Respiratory Distress Syndrome

Clinicians have long known the severe pulmonary complications that can accompany life-threatening illness or injury. In 1967, Ashbaugh and colleagues described what has now become known as the acute respiratory distress syndrome (ARDS). Their initial description of the syndrome in civilian patients was further appreciated in victims of nonthoracic trauma during the Vietnam War. ARDS has been known by other terms including: Da Nang lung, shock lung, noncardiogenic pulmonary edema and wet lung. ARDS is well described in pediatric patients and therefore “acute respiratory distress syndrome” should be used in place of “adult respiratory distress syndrome”. In 1994, a European-American Consensus Conference formalized a working definition for both acute lung injury and the acute ­respiratory distress syndrome (Table 24-1). While these definitions are still broadly utilized, many in pediatrics feel that oxygenation index [(mean airway pressure X Fi02) / PaO2] is a more accurate marker of true oxygenation defect.