Acute respiratory distress syndrome in children as a systemic pathological process

   Pediatric acute respiratory distress syndrome (PARDS) remains one of the most complex and clinically significant forms of acute respiratory failure (ARF) in pediatric intensive care. High variability of the clinical course, limited effectiveness of standard respiratory strategies, and unfavorable outcomes in a subset of patients indicate the insufficiency of traditional pathogenetic concepts predominantly based on the alveolar-inflammatory model. This article considers PARDS as a systemic pathological process driven by the sequential involvement of microcirculatory, energetic and regulatory mechanisms.

   Particular attention is paid to endothelial dysfunction, impaired tissue perfusion, and mitochondrial dysfunction as key factors underlying the development of energy deficiency and the limitation of process reversibility.

   It is shown that hypoxemia and ARF within this paradigm represent clinical manifestations of a deeper hypoxic-ischemic cascade affecting both the lungs and the central nervous system. The proposed concept has practical significance for improving the understanding of pathogenesis, stratifying disease severity, and assessing prognosis in PARDS.

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