Acute Respiratory Distress Syndrome Clinical Trial
Official title:
Acute Lung Injury in Spanish Children
The investigators propose to perform a one-year prospective audit of all Acute lung injury (ALI)and cute respiratory distress syndrome (ARDS) pediatric patients managed in several ICUs in Spain. The investigators intend to collect data from all children (from 1 month to 18 years of age) admitted with or developing ALI/ARDS with the aim to understand the epidemiology and natural history of acute lung injury in the pediatric setting. These ICUs are scattered through the Spain and are representative of the demographic differences across the country.
Acute lung injury (ALI) is a clinical syndrome of rapid onset of non-cardiogenic pulmonary
edema manifested clinically by hypoxemia (PaO2/FiO2≤300 mmHg) and bilateral pulmonary
infiltrates. When the hypoxemia is severe (PaO2/FiO2≤200 mmHg) it is termed the acute
respiratory distress syndrome (ARDS). It represents a significant public health issue.
Patients with ALI or ARDS require admission into critical care units for advanced life
support and utilize considerable health care resources.
An immense plethora of translational knowledge has been acquired since the first description
of ARDS in 1967. At the present, estimates of the incidence of ARDS and ALI in children are
unknown. In adults, the estimates of ALI/ARDS incidence have varied widely, and the true
magnitude of this health problem still remains unclear. Current estimates of the incidence
of adult ALI/ARDS range from 15 to 80 cases per 100.000 population, or almost 40.000 cases
per year in Spain. Combined mortality rates for adult ALI/ARDS range between 30-45% but it
is not clear whether this figures can be translated in the pediatric population. ALI and
ARDS occur as a complication or as the primary cause of critical illness in patients,
usually after severe infection or trauma.
Published epidemiological studies on ALI and ARDS in the last 20 years are difficult to
compare. Some reports have used different definitions for ALI and ARDS and others have
evaluated the incidence during a short period of time (from days to several weeks) and then
extrapolated their data to estimates of a one-year incidence. Very few studies have
collected information for an entire year, and none of them have evaluated the degree of
hypoxemia under standard ventilatory settings, as it has been proposed recently by the HELP
Network (Am J Respir Crit Care Med 2007; 176:795-804).
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