Skip to main content
SpringerLink
Log in

Respiratory Complications: Acute Respiratory Distress Syndrome, Chylothorax, Diaphragmatic Palsy and Paresis, Respiratory Physiotherapy, and Tracheostomy

  • Chapter
  • First Online:
Critical Care of Children with Heart Disease

  • 1553 Accesses

Abstract

This chapter addresses the respiratory complications/issues that can occur in pediatric cardiac intensive care unit. Pulmonary complications are prevalent in the critically ill cardiac patients, and the acute respiratory distress syndrome (ARDS), chylothorax, and diaphragmatic dysfunction after cardiac surgery are frequently encountered in pediatric cardiac intensive care unit.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ashbaugh DG, Bigelow DB, Petty TL, et al. Acute respiratory distress in adults. Lancet. 1967;2:319–323.

    Google Scholar 

  2. Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818–824.

    Google Scholar 

  3. Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5):428–439.

    Google Scholar 

  4. Sapru A, Flori H, Quasney MW, Dahmer MK; Pediatric Acute Lung Injury Consensus Conference Group. Pathobiology of acute respiratory distress syndrome. Pediatr Crit Care Med. 2015;16(5 Suppl 1):S6–S22.

    Google Scholar 

  5. Thompson BT, Chambers RC, Liu KD. Acute Respiratory Distress Syndrome. N Engl J Med. 2017;377(19):1904–1905.

    Google Scholar 

  6. Tolle LB, Standiford TJ. Danger-associated molecular patterns (DAMPs) in acute lung injury.J Pathol. 2013;229(2):145–156.

    Google Scholar 

  7. Xiang M, Fan J. Pattern recognition receptor-dependent mechanisms of acute lung injury. Mol Med. 2010;16(1–2):69–82. https://doi.org/10.2119/molmed.2009.

  8. Fremont RD, Koyama T, Calfee CS, Wu W, Dossett LA, Bossert FR, Mitchell D, Wickersham N, Bernard GR, Matthay MA, May AK, Ware LB. Acute lung injury in patients with traumatic injuries: utility of a panel of biomarkers for diagnosis and pathogenesis. J Trauma. 2010;68(5):1121–1127.

    Google Scholar 

  9. Parsons PE, Matthay MA, Ware LB, Eisner MD; National Heart, Lung, Blood Institute Acute Respiratory Distress Syndrome Clinical Trials Network. Elevated plasma levels of soluble TNF receptors are associated with morbidity and mortality in patients with acute lung injury. Am J Physiol Lung Cell Mol Physiol. 2005;288(3):L426–L431.

    Google Scholar 

  10. Lanchou J, Corbel M, Tanguy M, Germain N, Boichot E, Theret N, Clement B, Lagente V, Malledant Y. Imbalance between matrix metalloproteinases (MMP-9 and MMP-2) and tissue inhibitors of metalloproteinases (TIMP-1 and TIMP-2) in acute respiratory distress syndrome patients. Crit Care Med. 2003;31(2):536–542.

    Google Scholar 

  11. Newth CJ, Stretton M, Deakers TW, Hammer J. Assessment of pulmonary function in the early phase of ARDS in pediatric patients. Pediatr Pulmonol. 1997;23(3):169–175.

    Google Scholar 

  12. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1334–1349.

    Google Scholar 

  13. Matthay MA. Alveolar fluid clearance in patients with ARDS: does it make a difference? Chest. 2002;122(6 Suppl):340S–343S.

    Google Scholar 

  14. Matthay MA, Fukuda N, Frank J, Kallet R, Daniel B, Sakuma T. Alveolar epithelial barrier. Role in lung fluid balance in clinical lung injury. Clin Chest Med. 2000;21(3):477–490.

    Google Scholar 

  15. Ware LB, Fang X, Wang Y, Sakuma T, Hall TS, Matthay MA. Selected contribution: mechanisms that may stimulate the resolution of alveolar edema in the transplanted human lung.J Appl Physiol (1985). 2002;93(5):1869–1874.

    Google Scholar 

  16. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Matthay MA, Brower RG, Carson S, Douglas IS, Eisner M, Hite D, Holets S, Kallet RH, Liu KD, MacIntyre N, Moss M, Schoenfeld D, Steingrub J, Thompson BT. Randomized, placebo-controlled clinical trial of an aerosolized β2-agonist for treatment of acute lung injury. Am J Respir Crit Care Med. 2011;184(5):561–568.

    Google Scholar 

  17. Sato H, Callister ME, Mumby S, Quinlan GJ, Welsh KI, duBois RM, Evans TW. KL-6 levels are elevated in plasma from patients with acute respiratory distress syndrome. Eur Respir J. 2004;23(1):142–145.

    Google Scholar 

  18. Kawasaki Y, Endo K, Suyama K, Sato M, Ito M, Hashimoto K, Hosoya M. Serum SP-D levels as a biomarker of lung injury in respiratory syncytial virus bronchiolitis. Pediatr Pulmonol. 2011;46(1):18–22.

    Google Scholar 

  19. Liu X, Chen Q, Shi S, Shi Z, Lin R, Tan L, Yu J, Shu Q, Fang X. Plasma sRAGE enables prediction of acute lung injury after cardiac surgery in children. Crit Care. 2012;16(3):R91.

    Google Scholar 

  20. Wort SJ, Evans TW. The role of the endothelium in modulating vascular control in sepsis and related conditions. Br Med Bull. 1999;55(1):30–48.

    Google Scholar 

  21. Sapru A, Calfee CS, Liu KD, Kangelaris K, Hansen H, Pawlikowska L, Ware LB, Alkhouli MF, Abbott J, Matthay MA; NHLBI ARDS Network. Plasma soluble thrombomodulin levels are associated with mortality in the acute respiratory distress syndrome. Intensive Care Med. 2015;41(3):470–478.

    Google Scholar 

  22. Flori HR, Ware LB, Milet M, Matthay MA. Early elevation of plasma von Willebrand factor antigen in pediatric acute lung injury is associated with an increased risk of death and prolonged mechanical ventilation. Pediatr Crit Care Med. 2007;8(2):96–101.

    Google Scholar 

  23. Orfanos SE, Armaganidis A, Glynos C, Psevdi E, Kaltsas P, Sarafidou P, Catravas JD, Dafni UG, Langleben D, Roussos C. Pulmonary capillary endothelium-bound angiotensin-converting enzyme activity in acute lung injury. Circulation. 2000;102(16):2011–2018.

    Google Scholar 

  24. Sabharwal AK, Bajaj SP, Ameri A, Tricomi SM, Hyers TM, Dahms TE, Taylor FB Jr, Bajaj MS. Tissue factor pathway inhibitor and von Willebrand factor antigen levels in adult respiratory distress syndrome and in a primate model of sepsis. Am J Respir Crit Care Med. 1995;151(3 Pt 1):758–767.

    Google Scholar 

  25. Dahmer MK, O’cain P, Patwari PP, Simpson P, Li SH, Halligan N, Quasney MW. The influence of genetic variation in surfactant protein B on severe lung injury in African American children.Crit Care Med. 2011;39(5):1138–1144.

    Google Scholar 

  26. Levi M, ten Cate H, van der Poll T. Endothelium: interface between coagulation and inflammation. Crit Care Med. 2002;30(5 Supple):S220–S224.

    Google Scholar 

  27. Matthay MA, Ware LB, Zimmerman GA. The acute respiratory distress syndrome. J Clin Invest. 2012;122(8):2731–2740.

    Google Scholar 

  28. Chapman HA, Li X, Alexander JP, Brumwell A, Lorizio W, Tan K, Sonnenberg A, Wei Y, Vu TH. Integrin α6β4 identifies an adult distal lung epithelial population with regenerative potential in mice.J Clin Invest. 2011;121(7):2855–2862.

    Google Scholar 

  29. Adams JA, Zabaleta IA, Stroh D, Johnson P, Sackner MA. Tidal volume measurements in newborns using respiratory inductive plethysmography.Am Rev Respir Dis. 1993;148(3):585–588.

    Google Scholar 

  30. Crapo RO, Morris AH, Clayton PD, Nixon CR. Lung volumes in healthy nonsmoking adults.Bull Eur Physiopathol Respir. 1982;18(3):419–425.

    Google Scholar 

  31. Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301–1308.

    Google Scholar 

  32. Deans KJ, Minneci PC, Suffredini AF, Danner RL, Hoffman WD, Ciu X, Klein HG, Schechter AN, Banks SM, Eichacker PQ, Natanson C. Randomization in clinical trials of titrated therapies: unintended consequences of using fixed treatment protocols. Crit Care Med. 2007;35(6):1509–1516.

    Google Scholar 

  33. Erickson S, Schibler A, Numa A, Nuthall G, Yung M, Pascoe E, Wilkins B; Paediatric Study Group; Australian and New Zealand Intensive Care Society. Acute lung injury in pediatric intensive care in Australia and New Zealand: a prospective, multicenter, observational study. Pediatr Crit Care Med. 2007;8(4):317–323.

    Google Scholar 

  34. Liu Q, Li W, Zeng QS, Zhong NS, Chen RC. Lung stress and strain during mechanical ventilation in animals with and without pulmonary acute respiratory distress syndrome. J Surg Res. 2013;181(2):300–307.

    Google Scholar 

  35. Rimensberger PC, Cheifetz IM; Pediatric Acute Lung Injury Consensus Conference Group. Ventilatory support in children with pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5 Suppl 1):S51–S60.

    Google Scholar 

  36. Graves L, Chayen G, Peat J, O’Leary F. A comparison of actual to estimated weights in Australian children attending a tertiary children‘s’ hospital, using the original and updated APLS, Luscombe and Owens, Best Guess formulae and the Broselow tape. Resuscitation. 2014;85(3):392–396.

    Google Scholar 

  37. Gauld LM, Kappers J, Carlin JB, Robertson CF. Prediction of childhood pulmonary function using ulna length. Am J Respir Crit Care Med. 2003;168(7):804–809.

    Google Scholar 

  38. Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD, Slutsky AS, Pullenayegum E, Zhou Q, Cook D, Brochard L, Richard JC, Lamontagne F, Bhatnagar N, Stewart TE, Guyatt G. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA. 2010;303(9):865–873.

    Google Scholar 

  39. Phoenix SI, Paravastu S, Columb M, Vincent JL, Nirmalan M. Does a higher positive end expiratory pressure decrease mortality in acute respiratory distress syndrome? A systematic review and meta-analysis. Anesthesiology. 2009;110(5):1098–1105.

    Google Scholar 

  40. Muscedere JG, Mullen JB, Gan K, Slutsky AS. Tidal ventilation at low airway pressures can augment lung injury. Am J Respir Crit Care Med. 1994;149(5):1327–1334.

    Google Scholar 

  41. Afshari A, Brok J, Møller AM, Wetterslev J. Inhaled nitric oxide for acute respiratory distress syndrome and acute lung injury in adults and children: a systematic review with meta-analysis and trial sequential analysis. Anesth Analg. 2011;112(6):1411–1421.

    Google Scholar 

  42. Tamburro RF, Kneyber MC; Pediatric Acute Lung Injury Consensus Conference Group. Pulmonary specific ancillary treatment for pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5 Suppl 1):S61–S72.

    Google Scholar 

  43. Willson DF, Thomas NJ, Markovitz BP, Bauman LA, DiCarlo JV, Pon S, Jacobs BR, Jefferson LS, Conaway MR, Egan EA; Pediatric Acute Lung Injury and Sepsis Investigators. Effect of exogenous surfactant (calfactant) in pediatric acute lung injury: a randomized controlled trial. JAMA. 2005;293(4):470–476. Erratum in: JAMA. 2005 Aug 24;294(8):900.

    Google Scholar 

  44. Willson DF, Thomas NJ, Tamburro R, Truemper E, Truwit J, Conaway M, Traul C, Egan EE; Pediatric Acute Lung and Sepsis Investigators Network. Pediatric calfactant in acute respiratory distress syndrome trial. Pediatr Crit Care Med. 2013;14(7):657–665.

    Google Scholar 

  45. Steinberg KP, Hudson LD, Goodman RB, Hough CL, Lanken PN, Hyzy R, Thompson BT, Ancukiewicz M; National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med. 2006;354(16):1671–1684.

    Google Scholar 

  46. Sud S, Friedrich JO, Adhikari NK, Taccone P, Mancebo J, Polli F, Latini R, Pesenti A, Curley MA, Fernandez R, Chan MC, Beuret P, Voggenreiter G, Sud M, Tognoni G, Gattinoni L, Guérin C. Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis. CMAJ. 2014;186(10):E381–E390.

    Google Scholar 

  47. Dalton HJ, Macrae DJ; Pediatric Acute Lung Injury Consensus Conference Group. Extracorporeal support in children with pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5 Suppl 1):S111–S117.

    Google Scholar 

  48. Quasney MW, López-Fernández YM, Santschi M, Watson RS; Pediatric Acute Lung Injury Consensus Conference Group. The outcomes of children with pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5 Suppl 1):S118–S131.

    Google Scholar 

  49. Parvathaneni K, Belani S, Leung D, Newth CJ, Khemani RG. Evaluating the Performance of the Pediatric Acute Lung Injury Consensus Conference Definition of Acute Respiratory Distress Syndrome. Pediatr Crit Care Med. 2017;18(1):17–25.

    Google Scholar 

  50. Buckley JR, Graham EM, Gaies M, Alten JA, Cooper DS, Costello JM, Domnina Y, Klugman D, Pasquali SK, Donohue JE, Zhang W, Scheurer MA. Clinical epidemiology and centre variation in chylothorax rates after cardiac surgery in children: a report from the Pediatric Cardiac Critical Care Consortium. Cardiol Young. 2017:1–8.

    Google Scholar 

  51. Mery CM, Moffett BS, Khan MS, Zhang W, Guzmán-Pruneda FA, Fraser CD Jr, Cabrera AG. Incidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institution database.J Thorac Cardiovasc Surg. 2014;147(2):678–86.e1; discussion 685–6. https://doi.org/10.1016/j.jtcvs.2013.09.068. Epub 2013 Nov 15.

  52. Kreutzer J, Kreutzer C. Lymphodynamics in Congenital Heart Disease: The Forgotten Circulation. J Am Coll Cardiol. 2017;69(19):2423–2427.

    Google Scholar 

  53. Savla JJ, Itkin M, Rossano JW, Dori Y. Post-Operative Chylothorax in Patients with Congenital Heart Disease. J Am Coll Cardiol. 2017;69(19):2410–2422.

    Google Scholar 

  54. El Tantawy AE, Imam S, Shawky H, Salah T. Diaphragmatic nerve palsy after cardiac surgery in children in Egypt: outcome and debate in management. World J Pediatr Congenit Heart Surg. 2013;4(1):19–23.

    Google Scholar 

  55. Smith BM, Ezeokoli NJ, Kipps AK, Azakie A, Meadows JJ. Course, predictors of diaphragm recovery after phrenic nerve injury during pediatric cardiac surgery. Ann Thorac Surg. 2013;96(3):938–42.

    Google Scholar 

  56. Akay TH, Ozkan S, Gultekin B, Uguz E, Varan B, Sezgin A, Tokel K, Aslamaci S. Diaphragmatic paralysis after cardiac surgery in children: incidence, prognosis and surgical management. Pediatr Surg Int. 2006;22(4):341–346.

    Google Scholar 

  57. Talwar S, Agarwala S, Mittal CM, Choudhary SK, Airan B. Diaphragmatic palsy after cardiac surgical procedures in patients with congenital heart. Ann Pediatr Cardiol. 2010;3(1):50–57.

    Google Scholar 

  58. Arborelius M Jr, Lilja B, Senyk J. Regional and total lung function studies in patients with hemidiaphragmatic paralysis. Respiration. 1975;32(4):253–264.

    Google Scholar 

  59. Placidi G, Cornacchia M, Polese G, Zanolla L, Assael BM, Braggion C. Chest physiotherapy with positive airway pressure: a pilot study of short-term effects on sputum clearance in patients with cystic fibrosis and severe airway obstruction. Respir Care. 2006;51(10):1145–1153.

    Google Scholar 

  60. Dohna-Schwake C, Ragette R, Teschler H, Voit T, Mellies U. IPPB-assisted coughing in neuromuscular disorders. Pediatr Pulmonol. 2006;41(6):551–557.

    Google Scholar 

  61. Ortiz-Pujols S, Boschini LA, Klatt-Cromwell C, Short KA, Hwang J, Cairns BA, Jones SW. Chest high-frequency oscillatory treatment for severe atelectasis in a patient with toxic epidermal necrolysis. J Burn Care Res. 2013;34(2):e112–e115.

    Google Scholar 

  62. Koenig E, Singh B, Wood J. Mechanical insufflation-exsufflation for an individual with Duchenne muscular dystrophy and a lower respiratory infection. Respirol Case Rep. 2016;5(2).

    Google Scholar 

  63. Mastropietro CW, Benneyworth BD, Turrentine M, Wallace AS, Hornik CP, Jacobs JP, Jacobs ML. Tracheostomy After Operations for Congenital Heart Disease: An Analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg. 2016;101(6):2285–2292.

    Google Scholar 

  64. Prodhan P, Agarwal A, ElHassan NO, Bolin EH, Beam B, Garcia X, Gaies M, Tang X. Tracheostomy Among Infants with Hypoplastic Left Heart Syndrome Undergoing Cardiac Operations: A multicenter Analysis.Ann Thorac Surg. 2017;103(4):1308–1314.

    Google Scholar 

  65. Cotts T, Hirsch J, Thorne M, Gajarski R. Tracheostomy after pediatric cardiac surgery: frequency, indications, and outcomes. J Thorac Cardiovasc Surg. 2011;141(2):413–418.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Critical Care Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA

    Jiuann-Huey Ivy Lin

  2. General Academic Pediatrics, Children’s Mercy Hospital, Kansas City, MO, USA

    Jennifer Exo

  3. Chief, Division of Cardiac Critical Care Medicine Executive Director, Telemedicine Co-director, Children’s National Heart Institute Professor of Pediatrics, George Washington University School of Medicine Children’s National Health System, Washington, DC, USA

    Ricardo A. Munoz

Authors
  1. Jiuann-Huey Ivy Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer Exo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ricardo A. Munoz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jiuann-Huey Ivy Lin .

Editor information

Editors and Affiliations

  1. Chief, Division of Cardiac Critical Care Medicine Executive Director, Telemedicine Co-director, Children’s National Heart Institute, Professor of Pediatrics, George Washington University School of Medicine, Children’s National Health System, Washington, DC, USA

    Ricardo A. Munoz

  2. Department of Pediatric Cardiothoracic Surgery, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Victor O. Morell

  3. Associate Medical Director, CHCO Heart Institute Head, Pediatric Cardiac Critical Care Program & Inpatient Services Director, Cardiac Intensive Care Unit Children’s Hospital Colorado, Tenured Professor of Pediatrics, Pediatric Cardiology and Intensive Care University of Colorado Denver, School of Medicine, Aurora, CO, USA

    Eduardo M. da Cruz

  4. Department of Pharmacy, Pediatric Critical Care, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Carol G. Vetterly

  5. Department of Pediatric Cardiothoracic Surgery, UPMC – Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Jose Pedro da Silva

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Lin, JH.I., Exo, J., Munoz, R.A. (2020). Respiratory Complications: Acute Respiratory Distress Syndrome, Chylothorax, Diaphragmatic Palsy and Paresis, Respiratory Physiotherapy, and Tracheostomy. In: Munoz, R., Morell, V., da Cruz, E., Vetterly, C., da Silva, J. (eds) Critical Care of Children with Heart Disease . Springer, Cham. https://doi.org/10.1007/978-3-030-21870-6_54

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-21870-6_54

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-21869-0

  • Online ISBN: 978-3-030-21870-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation