What's New in Acute Respiratory Distress Syndrome in Infants and Children

Acute respiratory distress syndrome (ARDS) was first described in 1967 by Asbough et al. as a clinical syndrome that occurs 24 to 48 hours after a direct or indirect lung injury [1]. It is characterised by dyspnea, tachypnea, hypoxemia refractory to oxygen therapy, decreased lung compliance, and diffuse alveolar infiltrates on chest X-ray. ARDS is a rare disorder in childhood. The incidence varies from 0.8 to 4.4% among all admissions to the paediatric ICU [2–8]. ARDS is a significant cause of morbidity in critically ill children. While therapeutic interventions remain supportive, the management of evolving acute lung injury is often a controversial issue in the paediatric ICU. There has been significant progress in our understanding of the pathophysiology of acute lung injury and in our understanding of how lung injury is often amplified in the course of mechanical support. This understanding has led to a strategic shift in ventilation style principally geared to optimally recruiting and then maintaining end-expira-tory lung volume, preventing the traumatic cycle of derecruitment-recruitment, and finally, limiting alveolar stretching during tidal inflation.