Articles: respiratory-distress-syndrome.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Aerosolized surfactant in adults with sepsis-induced acute respiratory distress syndrome. Exosurf Acute Respiratory Distress Syndrome Sepsis Study Group.
Patients with acute respiratory distress syndrome (ARDS) have a deficiency of surfactant. Surfactant replacement improves physiologic function in such patients, and preliminary data suggest that it may improve survival. ⋯ The continuous administration of aerosolized synthetic surfactant to patients with sepsis-induced ARDS had no significant effect on 30-day survival, length of stay in the intensive care unit, duration of mechanical ventilation, or physiologic function.
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Swiss medical weekly · May 1996
Review[Ventilation in the prone position in acute respiratory distress syndrome (ARDS)].
Prone position mechanical ventilation (PPV) secures an improvement in gas exchange in approximately two-thirds of ARDS patients. Recent experimental and clinical data suggest that PPV acts mainly by recruiting alveoli situated in the dorsal dependent regions which are collapsed under the superimposed weight of the overlying edema-laden lungs. The purpose of this article is to provide an overview of the basic pathophysiological mechanisms underlying PPV as well as to underscore the promising clinical results so far obtained with this technique. In spite of these results the place of PPV among the other ventilatory and pharmacological approaches in the supportive treatment of ARDS, and the possible beneficial or deleterious consequences of associating PPV with one or more of these therapeutic modalities, remains to be determined.
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Critical care medicine · May 1996
Correction of blood pH attenuates changes in hemodynamics and organ blood flow during permissive hypercapnia.
To determine whether changes in cardiac output, regional blood flow, and intracranial pressure during permissive hypercapnia are blood pH-dependent and can be attenuated by correction of intravascular acidemia. ⋯ Acute hypercapnia, induced within 1 hr, is associated with significant increases in cardiac output, organ blood flow, and intracranial pressure. These changes can be significantly attenuated by correction of blood pH with the administration of sodium bicarbonate, without adverse effects on hemodynamics.
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Comparative Study Clinical Trial
[Venovenous extracorporeal membrane oxygenation (ECMO) with a heparin-lock bypass system. An effective addition in the treatment of acute respiratory failure (ARDS)].
Mortality of severe acute respiratory distress syndrome (ARDS) in Germany is about 60%. Respiratory therapy can make the lung injury worse by high positive airway pressures, high tidal volumes and high inspiratory oxygen concentrations. Extracorporeal membrane oxygenation (ECMO) was employed to reduce aggressive mechanical ventilation, but it has not been proved to be superior to conventional ventilation. ⋯ CONCLUSION. In comparison with the historical results at our own institution, the present study demonstrates an improvement in the survival rate from 56% to 78% since ECMO has become available. We conclude that venovenous ECMO with a heparin-bonded bypass circuit is an effective additional option for the treatment of patients with severe ARDS.