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In oncohematologic children (acute leukemia and post bone-marrow transplant) affected by ARDS, even though the initial improvement of PaO2 leads to optimism regarding the beneficial effects of the treatment, the subsequent deterioration in PaO2 is in line with the evolution of the original pathology which remains fatal, probably due to definitive damage to alveolar epithelium.
Improvement in PaO2/FiO2 ratio was evident in the first 3 hours but progressively the effect reduced and gas exchanges deteriorated. Stable damage of pneumocytes type II and large amount of inactivating/inhibiting factors can be suspected in ARDS in oncohematologic children. From Marraro et al 1999.
Marraro G, Casiraghi G, Riva A. Cah Anesthesiol 1991