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Paediatric acute respiratory distress syndrome: consider the role of lymphatics
  1. Mimi Lu1,2,
  2. Elena Cavazzoni3,
  3. Hiran Selvadurai1,2 and
  4. Juerg Martin Burren3
  1. 1Respiratory and Sleep Department, Children's Hospital at Westmead, Westmead, New South Wales, Australia
  2. 2The University of Sydney Discipline of Child and Adolescent Health, Westmead, New South Wales, Australia
  3. 3Paediatric Intensive Care Unit, Children's Hospital at Westmead, Westmead, New South Wales, Australia
  1. Correspondence to Dr Mimi Lu; mimi.lu1{at}


We present a case of a 7-day-old male infant with severe respiratory disease requiring venoarterial extracorporeal membrane oxygenation therapy with evidence of lymphangiectasia on lung biopsy. Differentiating primary versus secondary lymphangiectasis in this patient remains a riddle despite extensive investigations including an infective screen, lung biopsy and whole-genome sequencing. In addition to the standard therapies used in paediatric acute respiratory distress syndrome, such as lung-protective ventilation, permissive hypoxaemia and hypercarbia, nursing in the prone position, early use of muscle relaxants, rescue intravenous corticosteroids and broad-spectrum antibiotics, the patient was also given octreotide despite the absence of a chylothorax based on the theoretical benefit of altering the lymphatic flow. His case raises an interesting discussion around the role of lymphatics in the pathophysiology of paediatric and adult respiratory distress syndrome and prompts the exploration of novel agents which may affect lymphatic vessels used as an adjunctive therapy.

  • Paediatric intensive care
  • Paediatrics
  • Respiratory medicine

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  • Contributors Patient was under the care of ML and EC. Report was written by ML, EC, HS and JMB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.