Articles: respiratory-distress-syndrome.
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The aim of the present study was to evaluate the hemodynamic and respiratory variations in patients with acute respiratory distress syndrome (ARDS) under two conditions: volume controlled ventilation (VCV) and pressure controlled inverse ratio ventilation (PCIRV). Seventeen patients with ARDS and the following criteria were included: lung injury score > 2.5 and peak inspiratory pressure > or = 40 cm H2O under VCV, constant flow and I/E ratio of 1/2. Measurements were obtained in VCV and after one hour in PCIRV with I/E ratio 2/1 using a similar PEEP value than VCV. ⋯ Our results show that PCIRV allow to ventilate patients with lower peak inspiratory and plateau pressures without significant changes in hemodynamic and oxygenation parameters. The conventional tidal volumes are excessive for lungs with SDRA, which is shown with the improvement in the static compliance and the airway pressures in PCIRV. PCIRV mode at the same PEEPt level as VCV, with normal I/E ratio does not improve the oxygenation, despite the higher level of the mean airway pressure.
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The addition of replacement surfactant therapy to current neonatal intensive care techniques has brought about a significant reduction in the severity of, and mortality from, moderate-to-severe RDS in premature infants. Although exogenous surfactant is relatively easy to administer, its use should be limited to those skilled in handling critically-ill infants on ventilators. While its introduction has been a major step forward, it is not the whole answer to the vexing problem of respiratory distress syndrome.