Articles: respiratory-distress-syndrome.
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The pathogenesis of chronic neonatal lung disease involves the combined iatrogenic insults of oxygen toxicity and barotrauma in addition to lung inflammation. Newer ventilator strategies using smaller tidal volumes (3-7 mL/kg) in order to avoid overdistension, higher positive end-respiratory pressure and lower peak inspiratory pressures decrease barotrauma. Earlier reduction of FiO2 through the use of surfactant, high frequency ventilation and nitric oxide reduce oxygen toxicity. Other measures include careful fluid balance, avoidance of prolonged paralysis and early steroids to decrease inflammation.
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Intensive care medicine · Dec 1996
Comparative StudyPressure-limited ventilation with permissive hypercapnia and minimum PEEP in saline-lavaged rabbits allows progressive improvement in oxygenation, but does not avoid ventilator-induced lung injury.
To determine whether pressure-limited intermittent mandatory ventilation with permissive hypercapnia and positive end-expiratory pressure (PEEP) titrated to arterial oxygen tension (PaO2) prevents or reduces acute lung injury, compared to conventional ventilation, in saline-lavaged rabbits. ⋯ This ventilatory protocol may have failed to prevent lung overdistension or it may have provided insufficient PEEP to prevent injury in this model; PEEP greater than the lower inflection point of the pressure-volume curve has been shown to prevent injury almost entirely.
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Intensive care medicine · Dec 1996
New aspects of pulmonary mechanics: "slowly" distensible compartments of the respiratory system, identified by a PEEP step maneuver.
The aims of the present study were 1) to evaluate a method for identification of "slowly" distensible compartments of the respiratory system (rs), which are characterized by long mechanical time constants (RC) and 2) to identify "slowly" distensible rs-compartments in mechanically ventilated patients. ⋯ The gas distribution properties of the respiratory system can be easily studied by a PEEP-step maneuver. The relative contribution of the "slow" units to the total increase of lung volume following a PEEP step could be adequately assessed. "Slowly" distensible rs-compartments could be detected in patients with severe and mild lung injury, however significantly more ARDS patients revealed "slow" rs-compartments in PEEP-decreasing steps. The influence of "slowly" distensible rs-compartments on pulmonary gas exchange is unknown and has yet to be studied.
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Nihon Kyobu Shikkan Gakkai Zasshi · Dec 1996
[Defensin in plasma and in bronchoalveolar lavage fluid from patients with acute respiratory distress syndrome].
We measured the levels of defensins, antimicrobial peptides, and cytotoxic peptides in azurophil granules of neutrophils in plasma, and in bronchoalveolar lavage fluid (BALF) from patients with the acute respiratory distress syndrome (ARDS). High levels of plasma defensins were observed in samples from patients with ARDS. ⋯ A significant correlation was found between the concentration of defensins and that of IL-8 in BALF from patients with ARDS. These findings suggest that the lung injury in ARDS is caused by defensins released by neutrophils that accumulate in the lungs.