Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Clinical Outcome and Prognostic Factors of Acute Respiratory Distress Syndrome in Children

소아 급성 호흡곤란 증후군의 치료 성적 및 예후 인자

  • Ko, Jung-Min (Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Ha, Eun-Ju (Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Lee, Eun-Hee (Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Lee, So-Youn (Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Kim, Hyo-Bin (Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Hong, Soo-Jong (Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Park, Seong-Jong (Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan)
  • 고정민 (울산대학교 의과대학 서울아산병원 소아과) ;
  • 하은주 (울산대학교 의과대학 서울아산병원 소아과) ;
  • 이은희 (울산대학교 의과대학 서울아산병원 소아과) ;
  • 이소연 (울산대학교 의과대학 서울아산병원 소아과) ;
  • 김효빈 (울산대학교 의과대학 서울아산병원 소아과) ;
  • 홍수종 (울산대학교 의과대학 서울아산병원 소아과) ;
  • 박성종 (울산대학교 의과대학 서울아산병원 소아과)
  • Received : 2005.01.27
  • Accepted : 2005.03.07
  • Published : 2005.06.15
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Abstract

Purpose : The purpose of this study was to examine the causes, clinical courses and outcomes in children with acute respiratory distress syndrome(ARDS), and evaluate the physiologic variables as prognostic factors in the patients. Methods : Retrograde medical chart review was carried out in 24 patients who were diagnosed with ARDS at the pediatric intensive care unit(PICU) during 20-month period. Results : The incidence of ARDS among all PICU admission was 3.7 percent and the mortality rate was 37.5 percent, which was 14.8 percent of overall deaths in PICU. The most common causes of ARDS were pneumonia and sepsis. We found significant differences between survivors and nonsurvivors in $PaO_2/FiO_2$ ratio(P/F ratio), alveolar arterial oxygen gradient and oxygenation index(OI) on the second day from the onset of ARDS. Therapies for ARDS such as high frequency oscillator ventilation(HFOV), recruitment maneuver and low dose corticosteroid improved the P/F ratio and OI, especially in survivors. Conclusion : The mortality rate of children with ARDS was 37.5 percent; an important cause of death in PICU. HFOV, recruitment maneuver and low dose corticosteroid seemed to be effective in pediatric ARDS. The P/F ratio, alveolar arterial oxygen gradient and OI on the second day from the onset of ARDS may be useful as prognostic factors.

목 적 : 본 연구에서는 소아 ARDS의 원인, 임상양상 및 경과를 조사하였고, 급성 호흡곤란 증후군의 예후 인자로서 적용되는 지표들의 유용성을 평가하고자 하였으며, 여러 치료법을 적용한 후의 임상적 효과를 관찰하였다. 방 법 : 2002년 10월부터 2004년 6월까지 20개월 동안 서울아산병원 소아중환자실에서 ARDS로 진단받은 24명의 환자를 대상으로 의무 기록을 후향적으로 분석하였다. 결 과 : 대상 기간 동안 소아중환자실 입원 환아 중 ARDS의 유병률은 3.7%였고, 사망률은 37.5%로 소아중환자실내 전체 사망 원인의 14.8%를 차지하였다. 폐렴과 패혈증이 중요한 발생 원인이었고, 폐내원인에 비해 폐외원인의 경우 사망률이 더 높았다. 치료에 있어 고빈도 환기요법, 폐포모집술, 저용량 스테로이드 투여 후 P/F 비와 산소화지수 등의 지표에서 호전을 보였으며, 특히 생존 환아군에서 더 큰 호전을 보였다. 치료 초기에 환아의 예후를 예측할 수 있는 지표로는 ARDS 진단 2일째의 P/F 비와 폐포-동맥간 산소분압차, 산소화지수가 통계학적으로 유의하였다. 결 론 : 저자들이 경험한 소아 ARDS의 사망률은 37.5%였으며, 치료에 있어 고빈도 환기요법, 폐포모집술 및 후기 저용량 스테로이드의 투여가 효과적인 것으로 생각된다. 또한 ARDS 진단 2일째의 P/F 비와 폐포-동맥간 산소분압차, 산소화지수의 호전 정도가 환아의 예후를 예측하는데 유용하리라 여겨진다.

Keywords

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