Articles: respiratory-distress-syndrome.
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At our institution, PLV continues to be used as an investigational therapy for patients with ARDS who meet the protocol criteria. Since this is the beginning of the first nonneonatal clinical trial of PLV, results of this therapy are not yet available. ⋯ Other questions to be answered include the cost-effectiveness of using this therapy for patients with ARDS, as well as what type of program will be required to carry out this therapy. It is hoped that this type of ventilatory therapy will offer an effective, simple method of treatment for patients with ARDS in the future.
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Induced hypothermia as adjunctive therapy has been the subject of considerable research interest and debate for over fifty years. Recently the first prospective randomized controlled trials were undertaken in humans with severe traumatic brain injury, with supportive results. Another prospective controlled study of induced hypothermia in severe septic adult respiratory distress syndrome also suggested improved outcome. ⋯ In addition, hypokalaemia, prolonged clotting times and neutropenia may occur. The evidence that induced hypothermia may be hazardous is mostly drawn from the literature on accidental hypothermia occurring in trauma, or patients with sepsis. It is likely that further trials will be conducted and if benefit is confirmed, induced hypothermia may become more widely used in selected patients in the intensive care unit.
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The aim of this study was to determine predictors of response whilst using high frequency jet ventilation (HFJV) for infants in intractable respiratory failure, in order to avoid the utilization of extracorporeal membrane oxygenation (ECMO). We reviewed patient demographics, ventilator parameters, blood gas values, length of oxygen therapy and use of surfactant and outcome, in infants given a 4 h trial of HFJV as the minimum to eliminate those infants where HFJV is used as a bridge to ECMO. The study was carried out in the neonatal intensive care nursery at Kosair Children's Hospital in Louisville, Kentucky, which provides high frequency ventilation and ECMO. ⋯ No statistical differences were found in length of ventilation, days of oxygen therapy or duration of HFJV between the groups. Infants in intractable respiratory failure, who are eligible for extracorporeal membrane oxygenation, should receive a trial of high frequency jet ventilation, especially if the cause is respiratory distress syndrome unresponsive to surfactant therapy. During high frequency jet ventilation, the oxygenation index and mean airway pressure should be monitored serially, since they may predict the need for extracorporeal membrane oxygenation.
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J. Allergy Clin. Immunol. · Jun 1996
Detection of IL-5 and IL-1 receptor antagonist in bronchoalveolar lavage fluid in acute eosinophilic pneumonia.
Acute eosinophilic pneumonia is an idiopathic cause of respiratory failure, characterized by very high numbers of alveolar eosinophils without significant blood eosinophilia. ⋯ Acute eosinophilic pneumonia is characterized by locally high levels of IL-5, IL-1ra, and soluble type II IL-1 receptor in the alveolar space.