Background and aims Pulmonary hypertension can complicate acute respiratory distress syndrome (ARDS). This study evaluated the degree of pulmonary hypertension and the alteration in the pulmonary vascular resistance (PVR) in children with ARDS.

Patients and methods The study included 20 critically ill mechanically ventilated ARDS patients in the PICU of Ain Shams University Hospital.

Doppler echocardiography was done to assess the pulmonary artery pressure. PVR was calculated using the equation (PVR= TRV/TVI (RVOT) x10 + 0.16) with a cut off value of 0.175 to determine PVR > 2 wood unit.

Results The study included 20 patients with a median age of 6.3 months and IQR of (4.3–28.5) months. The mean ARDS score was 3.7 ± 0.5. Eighteen patients (90%) had elevated RVSP and PVR when compared to the normal standard values. The median and IQR of RVSP were higher among the studied population 44.5 (36.3–48.5 mmHg) when compared to the control group 25 (23.5–26 mmHg) (p < 0.001). The median and IQR of the estimated PVR were higher among the studied population 2.6(2.1–3.4) when compared to the control group 1.5(1.1- 1.6) (p < 0.001). There was a statistically significant negative correlation between the hypoxemic index (PaO2/FiO2) and the TRV (r = -0.474, P = 0.035). There was a significant positive correlation between FiO2 and TRV(r = 0.469, P = 0.037), and Pulmonary artery end-diastolic pressure (PAEDP) (r = 0.529, P = 0.017) and also between Peak inspiratory pressure (PIP) and PVR (r = 0.513, P = 0.021).

Conclusion Hypoxemia resulted from ARDS can adversely affect the pulmonary vascular bed.