Articles: respiratory-distress-syndrome.
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Am. J. Respir. Crit. Care Med. · Apr 1997
Randomized Controlled Trial Multicenter Study Clinical TrialBovine surfactant therapy for patients with acute respiratory distress syndrome.
Lung surfactant is deficient in patients with acute respiratory distress syndrome (ARDS). We performed a randomized, prospective, controlled, open-label clinical study of administration of a bovine surfactant to patients with ARDS to obtain preliminary information about its safety and efficacy. Patients received either surfactant by endotracheal instillation in addition to standard therapy or standard therapy only. ⋯ Mortality in the same group of patients was 18.8%, as compared with 43.8% in the control group (p = 0.075). The surfactant instillation was generally well tolerated, and no safety concerns were identified. This pilot study presents preliminary evidence that surfactant might have therapeutic benefit for patients with ARDS, and provides rationale for further clinical study of this agent.
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Clinical Trial
Prone postioning and low-volume pressure-limited ventilation improve survival in patients with severe ARDS.
Investigating the effect of low-volume pressure-limited ventilation and repeated prone positioning on the short-term course and outcome in patients with severe ARDS. ⋯ We assume that our low mortality in patients with severe ARDS might be due mainly to low-volume pressure-limited ventilation and prone positioning. This simple strategy seems to allow successful treatment for patients with severe ARDS.
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Critical care medicine · Apr 1997
Partial carbon dioxide rebreathing: a reliable technique for noninvasive measurement of nonshunted pulmonary capillary blood flow.
To determine the validity and clinical utility of the partial CO2 rebreathing technique for measurement of nonshunted pulmonary capillary blood flow and cardiac output. ⋯ Our results support the use of the system developed for breath-by-breath VCO2 measurements. The lack of agreement between partial CO2 rebreathing measurements and cardiac output was mostly explained by intrapulmonary right-to-left shunt, suggesting that this technique may not be appropriate for monitoring cardiac output in patients with increased venous admixture. In contrast, our results demonstrate that the partial CO2 rebreathing technique is reliable for measurement of the effective nonshunted pulmonary capillary blood flow. This technique may prove useful to guide ventilatory therapy adjustments in an attempt to optimize nonshunted pulmonary capillary blood flow.
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To determine the incidence of acute lung injury (ALI) in comatose patients after isolated traumatic brain injury, to determine whether specific brain lesions diagnosed by cranial computed tomographic scans are associated with ALI, and to determine the outcome of patients with head injuries who developed ALI. ⋯ ALI was common in comatose victims with an isolated traumatic brain injury and was associated with an increased risk of death or a severe neurological morbidity. ALI was associated with the global severity of head injury but not with specific anatomic lesions diagnosed by cranial computed tomographic scans.