الفهرس 
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Abstract
The acute respiratory distress syndrome is an acute inflammatory process of the lungs caused by direct or indirect insults to the alveolar-capillary membrane and is associated with an overall mortality ranging from 35% to 50%. Pathologically, ARDS is characterized by diffuse alveolar damage (DAD) with injury to the epithelium and endothelium as well as interstitial and alveolar protein-rich edema, inflammatory cellular infiltration, atelectasis, capillary thrombosis, neovascularization, and pulmonary fibrosis.
Clinically, this syndrome is defined by acute hypoxemia and bilateral pulmonary infiltrates, in the absence of congestive heart failure. As with other inflammatory process in the body, lung injury in ARDS is accompanied by several biochemical and cellular processes; some might initiate the syndrome, others might perpetuate it, and others could inactivate the inflammatory mediators. ARDS cannot be diagnosed by a single laboratory test. Since no specific ARDS biomarker has yet been described, it is likely that the incidence of what we currently consider to be ARDS is overestimated, The lack of a specific biomarker for ARDS is arguably one of the main obstacles in the diagnosis and successful treatment of this syndrome.
Early use of bedside lung ultrasound in pediatric intensive care units provides early diagnosis of most of acute lung conditions,follows up, proper monitoring of the cases and improves morbidity and mortality. Lung ultrasound used not only for rapid diagnosis of acute respiratory distress disease but also for early detection and follow up of treatment.
This study was a prospective open label randomized trial was carried out in Pediatric Intensive Care Unit, Pediatric Department, Ain Shams University Hospital on 40 patients aged from 1.5 month to 120 month (10 years), 26 male and 14 female from October 2019 to June 2021 The study was approved by the ethical committee of the faculty of medicine, Ain Shams University. An informed consent was obtained from the guardians of the patients included in the study. The cases were divided into two groups group I: twenty critically ill patients suffering from acute respiratory distress syndrome received low dose methyl prednisolone. 13 male, 7 female aged 2 months up to 108 month (9 years).group II: twenty critically ill patients suffering from acute respiratory distress syndrome received high dose methyl prednisolone. 13 male, 7 female aged 1.5 m0nth up to 120 month (10 years).
Inclusion criteria:
All Patients were diagnosed ARDS according to Berlin definition.
Criteria for ARDS diagnosis:
Pao2/Fio2 ratio ≤ 300 and > 200 is mild ARDS; Pao2/Fio2 ratio 100 - 200 is moderate ARDS; Pao2/Fio2 ratio ≤ 100 is sever ARDS in this new criteria the minimum level of PEEP required for diagnosis of ARDS is 5 cmH2o, Imaging criteria of ARDS is bilateral on chest x ray that cannot be explained by effusion, collapsed lung or lung nodules.
Exclusion criteria:
- Malignancy
- Immunodeficiency disorders.
- Atelectasis.
- Collapsed lung or lung nodules.
- Patients on steroid therapy before PICU admission.
All patients divided into two groups:
First group received 3 consequent daily low doses Methyl prednisone 2 mg/kg/day at the time of ARDS diagnosis, chest ultrasound and BAL done before and 3 days after steroid therapy.
Second group received 3 consequent daily high doses Methyl prednisone 30 mg/kg/day at the time of ARDS diagnosis, chest ultrasound and BAL done before and 3 days after steroid therapy was taken.
All patients included in this study were subjected to complete history taking, thorough clinical examination and all patients were evaluated by SOFA score which was done before and after steroid therapy, Also they were monitored for SaO2, ABG, CBC, Chest x ray, chest ultrasound, BAL for test pre collagen peptide before and after 3 days of steroid treatment.
The main investigation was; lung ultrasound was done before and after steroid treatment using BLUE score, Probe is putting in logutidnal position starting antertiol from the parasternal zone and posteriol from the paravertebral /posterior axillary zone, Suspected ARDS can be easily confirmed by lung ultrasonography through recognition of a typical pattern characterized by B-lines, Then done BLUE protocol score as the following points, Scoring system of lung ultrasound dividing chest into 6 points, Right side 3 point (upper, lower, lateral) and left side 3 point (upper, lower, lateral), where upper point above nipple mid clavicular line, lower point below nipple mid clavicular line, lateral point at posterior axillary line, in each point measure
A* B-lines number (no or less than 3 B lines equal in score zero, scattered B-Lines more than 3 lines equal in score 1, diffuse B lines affecting less than 50% of filed equal in score 2, diffuse B lines affecting more than 50% of filed equal in score 3)
B* lung sliding (if present equal in score 1, if absent equal in score zero)
C* pleural effusion (if present equal in score 1, if absent equal in score zero)
D* alveolar consolidation (absent equal in score zero, small patch < 1 cm in maximal dimension equal in score 1, patch between 1- 2 cm in maximal dimension equal in score 2, patch > 2 cm in maximal dimension equal in score 3)
Maximal total score for all points is 54 and we compare the total score of chest ultrasound before and after 3 days of treatment.
Also all patients were done Blind Broncho alveolar Lavage: At the time of ARDS diagnosis and 3 days after steroid therapy using blind non bronchoscopic broncho alveolar lavage protected double lumen catheter With assessment of:
- Human Pro collagen Type 1 N- Terminal Pro peptide ELISA Colorimetric.(Novus Biological Europe. NBP2- 76465.
from the present study we had the following results:
Regarding arterial blood gas there was non significant difference in arterial blood gases parameters between before and after use corticosteroid therapy
Regarding SOFA score there was non significant difference in SOFA score between before and after use corticosteroid therapy groups.
Regarding chest ultrasound there was chest ultrasound (BLUE) score no significant difference in number of B-Lines in lung areas between before and after use corticosteroid therapy groups.
Regarding pre collagen peptide there was no significant difference in increase in pre collagen peptide between before and after use corticosteroid therapy groups.
Regarding lung compliance there was significant difference in increase lung compliance between before and after use corticosteroid therapy groups.
Regarding prognosis and total days in PICU there was no significant difference in prognosis and total days in PICU between high and low dose corticosteroid therapy groups.
Study shows significant use of increase in SOFA score, decrease in chest ultrasound (BLUE) score, increase in lung compliance in used corticosteroid therapy in ARDS patients and shows non significance difference increase in pre collagen peptide as prognostic parameters in corticosteroid therapy in ARDS patients.