Adult-type respiratory distress syndrome in children. Experience with seven cases.

Adult respiratory distress syndrome (ARDS) is not well recognized in children. We report seven individuals, ranging in age from 1.5 to 16 years. The clinical picture of ARDS reached a peak in 72 hours from admission and was associated with a 28.5 per cent death rate (2/7). In no case was an organism isolated, either from bronchial washings via a flexible bronchoscope or from open lung biopsy specimen. ARDS is characterized by severe damage to the alveolar-capillary unit and probably inadequate production of lung surfactant, resulting in severe hypoxia, hypoxemia, intrapulmonary shunting, and marked decline in pulmonary compliance. The prognosis remains poor in the pediatric age group. The pathophysiology of this entity is outlined, with guidance for monitoring and therapy.