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Adult respiratory distress syndrome in severely neutropenic children
Author(s) -
Sivan Yakov,
Mor Celia,
AlJundi Sana,
Newth Christopher J. L.
Publication year - 1990
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.1950080208
Subject(s) - ards , medicine , respiratory distress , histopathology , diffuse alveolar damage , neutropenia , lung , infiltration (hvac) , pathology , respiratory disease , chemotherapy , anesthesia , acute respiratory distress , physics , thermodynamics
It has been suggested that polymorphonuclear cells (PMNs) are required for the development of the adult respiratory distress syndrome (ARDS). We investigated the occurrence of ARDS with acute respiratory failure in 30 children with severe neutropenia (<500 PMNs/mm 3 ) who met the clinical diagnostic criteria for ARDS and in whom postmortem histopathology findings were available within 7 days of the onset of ARDS. In 26 patients the histopathology was consistent with ARDS. In 12/26 children no white blood cells (WBC) were found in the lung tissue, 10/26 had moderate infiltration of mononuclear cells, 2/26 had massive tumor cell infiltration, and in 2/26 PMNs were found. Thus, in at least 22/26 patients ARDS developed without neutrophilic infiltration of the lungs. The maximum active lung infection rate was found to be 69% (18/26) by endotracheal and post mortem lung cultures and histology. Thus 5/26 children had ARDS without any WBC in the lung tissue. We conclude, as have other studies in adults that the absence of PMNs does not protect children from the development of ARDS and that the mechanism which involves PMNs is probably only one of several pathways for diffuse alveolar damage, some of which is neutrophil‐independent. Pediatr Pulmonol 1990; 8:104‐108.