Articles: respiratory-distress-syndrome.
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Klinische Pädiatrie · Mar 1997
[Simultaneous measurements of end-expiratory and transcutaneous carbon dioxide partial pressure in ventilated premature and newborn infants].
The aim of the present trial was to study the relationship between end-tidal pCO2 (p(et)CO2) and transcutaneous pCO2 (ptcCO2) after in-vivo calibration in ventilated newborns. ⋯ Capnographic determination of P(et)CO2 provides informations about alveolar ventilation-perfusion-disturbances. Capnography enables the on-line control of end-tidal pCO2 in neonates with respiratory failure. It cannot replace transcutaneous pCO2 measurements or blood gas analysis but it can reduce its frequency in clinically stable patients. The analysis of the capnogram can be used to optimise artificial ventilation. A quantitative evaluation of the capnogram by calculation of Murányi's-CO2-Index was possible only in 28% of the ventilated newborns which limits its value in such patients.
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Clinical Trial
Extracorporeal membrane oxygenation for transport of hypoxaemic patients with severe ARDS.
Conventional inter-hospital transfer of patients with severe acute respiratory distress syndrome (ARDS) in need of extracorporeal membrane oxygenation (ECMO) may be risky and in severe hypoxaemic patients may be associated with cerebral hypoxia and death. Therefore, we began a phase 1 study to evaluate the feasibility, complications and outcome of inter-hospital transport of these patients using veno-venous ECMO. Eight patients with severe ARDS and a PaO2/FIO2 < 6.7 kPa at a PEEP > or = 10 cm H2O were placed on a mobile ECMO at the referring hospital. ⋯ No significant complications occurred. Six patients survived and were discharged from hospital; two patients died because of multiple organ failure. We conclude that initiation of ECMO in hypoxaemic patients before inter-hospital transfer is feasible and enables safe transport to an ECMO centre.
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Review Case Reports
Pseudopulmonary embolism: acute respiratory distress in the syndrome of heparin-induced thrombocytopenia.
A 73-year-old man with myasthenia gravis was treated with daily plasmapheresis. During the course of treatment, the patient developed progressive thrombocytopenia and an episode of severe acute respiratory distress suggesting pulmonary embolism. ⋯ The time frame of clinical events suggests a heparin-mediated mechanism for both the thrombocytopenia and respiratory compromise. We conclude that acute respiratory distress may be the presenting manifestation of the syndrome of heparin-associated thrombocytopenia in patients treated with dialysis or apheresis.
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Despite good results in neonates, extracorporeal membrane oxygenation (ECMO) is less well accepted in pediatric patients. Older children frequently undergo ECMO for severe bacterial, viral, or aspiration pneumonia and many have coexisting systemic sepsis. We reviewed data from a national registry to study the influence of sepsis on survival from ECMO. ⋯ Systemic sepsis does not independently influence survival in pediatric ECMO. This therapy should not be withheld solely because of sepsis, although neurologic complications may occur more frequently.