Articles: respiratory-distress-syndrome.
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To determine the relation between 1) intra-alveolar concentrations of the proinflammatory cytokines (tumor necrosis factor, interleukin-1 beta, and interleukin-8) and the anti-inflammatory cytokines (interleukin-10 and interleukin-1 receptor antagonist) in patients with early adult respiratory distress syndrome (ARDS) and 2) subsequent patient mortality rates. ⋯ Low concentrations of the anti-inflammatory cytokines interleukin-10 and interleukin-1 receptor antagonist in bronchoalveolar lavage fluid obtained from patients with early ARDS are closely associated with poor prognosis. These findings support the hypothesis that failure to mount a localized intrapulmonary anti-inflammatory response early in the pathogenesis of ARDS contributes to more severe organ injury and worse prognosis. Our findings suggest that augmenting anti-inflammatory cytokine defenses would be a beneficial therapeutic approach to patients with ARDS and other inflammatory diseases.
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Comparative Study
[Gas exchange and hemodynamic effects of nitric oxide inhalation in patients with acute respiratory distress syndrome].
To analyze the effects on gas exchange and hemodynamics of nitric oxide inhalation in patients with acute respiratory distress syndrome. ⋯ Low doses of inhaled nitric oxide induce a selective pulmonary vasodilatation and significant improvement of oxygenation in the majority of acute respiratory distress syndrome patients, although those with a hyperkinetic hemodynamic status are less likely to improve the oxygenation. These effects are maintained for at least 5 days. We did not observe rebound effects.
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Critical care clinics · Jul 1996
ReviewHigh-inflation pressure and positive end-expiratory pressure. Injurious to the lung? Yes.
There is a growing body of evidence suggesting that high levels of inflation pressure and high levels of PEEP may be injurious to lung tissue and other organ systems. Limiting peak alveolar pressures below 35 cm H2O may help in avoiding these injuries. The findings have led to the development of a lung-protective strategy that is based on physiologic parameters. ⋯ Usually a PEEP of 8 to 12 cm H2O is sufficient. Although we usually initiate mechanical ventilation with a volume-cycled mode, we are not hesitant to switch rapidly to a pressure-limited mode if results are unsatisfactory. We believe that more attention to the potential harmful effects of pressure and volume on lung architecture may result in further improvement of survival in patients with acute respiratory failure.
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Critical care medicine · Jul 1996
Randomized Controlled Trial Clinical TrialAn increase in serum C18 unsaturated free fatty acids as a predictor of the development of acute respiratory distress syndrome.
No means exist for predicting the acute respiratory distress syndrome (ARDS), which complicates sepsis, trauma, and a variety of clinical disorders. Because activation of phospholipid-signaling pathways involving the acyl chains oleate and linoleate may initiate and amplify the inflammatory response, and thereby lead to the development of ARDS, we examined whether serum concentrations of these bioactive lipids increase and are predictive of ARDS in at-risk patients. ⋯ Increases in unsaturated serum acyl chain ratios differentiate between healthy and seriously iII patients, and identify those patients likely to develop ARDS. Thus, the serum acyl ratio may not only prospectively identify and facilitate the assessment of new treatments in patients at highest risk for developing ARDS, but may also lead to new insights about the pathogenesis of ARDS.
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Am. J. Respir. Crit. Care Med. · Jul 1996
Changes in the inflammatory response of the lung during acute respiratory distress syndrome: prognostic indicators.
We studied paired bronchoalveolar lavage (BAL) in patients with sepsis-associated acute respiratory distress syndrome (ARDS). Patients were evaluated at one institution and underwent bronchoscopy with BAL within 48 h of the onset of ARDS. Patients were restudied with bronchoscopy and BAL after 4 d of treatment. ⋯ In the follow-up lavage, there was a significant fall for the IL-8 concentrations for the survivors but not the nonsurvivors. We conclude that neutrophil influx in ARDS may rapidly resolve within a week of the onset of ARDS. The resolution of neutrophils was associated with a good prognosis.