الفهرس 
Acute Respiratory Distress Syndrome (ARDSOnly 14 pages are availabe for public view
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Abstract
Background: Acute Respiratory Distress Syndrome (ARDS) is a clinical condition secondary to a variety of insults leading to a severe acute respiratory failure and high mortality in critically ill patients. Patients with ARDS generally require mechanical ventilation, which is another important factor that may increase the ALI (acute lung injury) leading to ventilator-induced lung injury (VILI). Various ventilatory strategies had been studied in order to minimize VILI as open lung ventilation strategy and high frequency oscillatory ventilation (HFOV).
Aim of the work: To compare open lung ventilation strategy versus high frequency ventilation among pediatric patients with acute respiratory distress syndrome (ARDS) as regards the degree of ventilation induced lung injury (VILI) and the patient prognosis using bronchial alveolar lavage (BAL) level of angiopoietin-2 and surfactant protein b.
Subjects and methods: This is a prospective longitudinal cohort study; it was conducted on 40 patients admitted to the Pediatric Intensive Care Units (PICUs) of Ain Shams University Hospitals, they were fulfilling Berlin criteria for ARDS, half of them were ventilated using open lung ventilation strategy and the other half using HFOV, Patients were subjected to Full history taking, complete physical examination, PRISM and PELOD score assessment, fate of the patients, duration of the length of the stay in PICU, duration of mechanical ventilation , adverse effects that occurred during ventilation, blood cultures and BAL fluid assessment including cytology, culture and sensitivity and levels of surfactant protein b and Angiopoietin-2 assessment.
Results: Ang-2 concentration in BAL fluid aspirate was high in non survivors at hour 24 and hour 48 with p value of 0.013 and <0.001 respectively, While in hour zero there was no statistical difference between survivors and non survivors, , By comparing the BAL aspirate levels (zero, 24, 48 hours and delta change at 24 and 48 hours) of Ang-2 and SP-b in the two studied groups we found that there was no statistical difference between the two studied groups with p value >0.05
Conclusion: There was no difference between HFOV and low tidal volume ventilation strategy in treating patients with mild and moderate ARDS as regards the degree of VILI as assessed by ABG parameters analysis, BAL levels of Ang-2 and SP-b levels and the clinical outcome. Moreover, the Ang-2 concentration in BAL fluid aspirate was significantly higher in non survivors and level of Ang-2 at 24 h is a significant predictor of mortality.