Articles: respiratory-distress-syndrome.
-
We have studied prospectively the clinical course and serum concentrations of thromboxane B2 (TxB2) and leukotriene B4 (LTB4) in patients developing adult respiratory distress syndrome (ARDS) after oesophagectomy. The clinical course was assessed according to a validated ARDS score, and intra- and postoperative measurements of TxB2 and LTB4 in pre- and post-pulmonary blood were performed in 18 patients undergoing oesophagectomy for oesophageal carcinoma and 11 control patients undergoing thoracotomy and pulmonary resection. Six of 18 patients undergoing oesophagectomy, but no control patient, developed ARDS. ⋯ Only patients with ARDS had a significant postoperative increase in post-pulmonary, but not pre-pulmonary, TxB2 concentrations (P < 0.05 vs patients without ARDS). This study provides evidence that TxA2, originating from the lungs, was associated with the development of ARDS after oesophageal resection. In view of the high incidence of ARDS after oesophagectomy (10-30%), prophylactic treatment of patients undergoing oesophageal resection with clinically applicable thromboxane synthetase inhibitors may be warranted.
-
Pathol. Res. Pract. · Jan 1998
Case ReportsThe spatial distribution of pulmonary lesions in severe ARDS. An autopsy study of 35 cases.
The present study was undertaken in order to describe the local distribution and temporal course of pulmonary lesions in severe ARDS. We investigated a total of 35 patients (22 females), ranging in age from 2 to 51 years, who suffered from ARDS III and IV and were treated by extracorporeal CO2 removal and low frequency positive pressure ventilation (ECCO2-R). The extent of acute and chronic diffuse alveolar damage was assessed on histologic gross sections in the ventral, central and dorsal zone of the upper and lower lobes. ⋯ Hemorrhage occurred at the interface zone between chronic and acute DAD and made up a significant volume portion of the lung tissue, ranging between 8% (lower lobes) and 42% (upper lobes). We conclude that the progression of acute DAD to chronic DAD is mainly determined by local factors (hydrodynamic and hydrostatic forces, intraalveolar pressure) that differ within the lung, whereas the duration of disease plays a minor role. Parenchymal hemorrhage occurs at the interface between areas of acute and chronic DAD and may therefore primarily be due to an increased susceptibility of the pulmonary parenchyma to mechanical stress.
-
Despite intensive therapeutic efforts, adult respiratory distress syndrome (ARDS) is still associated with a lethality ranging from 50 to 80%. Besides hypoxemia, fatal outcome is caused by myocardial insufficiency due to a progressive decrease in pulmonary vascular conductance. Inhalation of NO can selectively dilate pulmonary vessels in ventilated lung regions, thus increasing mean pulmonary artery conductance and decreasing venous admixture. ⋯ In severe ARDS, oxygenation significantly improves with the initiation of NO inhalation, but this effect declines over time. With NO, FiO2 and ventilatory pressures can be lowered. Whether the theoretically reduced oxygen toxicity and the reduced invasiveness of mechanical ventilation with NO reduces patient mortality must be determined in larger patient groups.