Mechanisms of ARDS in Children and Adults
The coagulation system is inextricably linked to acute inflammatory responses. Endothelial cell and platelet activation may lead to a consumptive coagulopathy in patients of all ages with sepsis or ARDS. Reduced levels of activated protein C (APC) have been associated with increased mortality in septic adult and pediatric patients. Ware et al have shown that APC is reduced in adult patients with ARDS; however, a randomized controlled trial of APC in adults with ARDS failed to show an improvement in outcomes. Increased von Willebrand factor antigen and plasminogen activator inhibitor-1 in plasma of adult and pediatric patients with ARDS are associated with increased mortality and fewer ventilator-free days.
Although targeting the coagulation system could have significant therapeutic benefit, there are no large human studies showing that this strategy reduces morbidity or mortality in patients with ARDS. Despite the apparent similarities between children and adults, future studies need to be carefully designed to determine the pathophysiology and therapeutic efficacy of targeting the coagulation system in children and adults with ARDS.
Coagulation
The coagulation system is inextricably linked to acute inflammatory responses. Endothelial cell and platelet activation may lead to a consumptive coagulopathy in patients of all ages with sepsis or ARDS. Reduced levels of activated protein C (APC) have been associated with increased mortality in septic adult and pediatric patients. Ware et al have shown that APC is reduced in adult patients with ARDS; however, a randomized controlled trial of APC in adults with ARDS failed to show an improvement in outcomes. Increased von Willebrand factor antigen and plasminogen activator inhibitor-1 in plasma of adult and pediatric patients with ARDS are associated with increased mortality and fewer ventilator-free days.
Although targeting the coagulation system could have significant therapeutic benefit, there are no large human studies showing that this strategy reduces morbidity or mortality in patients with ARDS. Despite the apparent similarities between children and adults, future studies need to be carefully designed to determine the pathophysiology and therapeutic efficacy of targeting the coagulation system in children and adults with ARDS.
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