Articles: respiratory-distress-syndrome.
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Acta Anaesthesiol Scand Suppl · Jan 1996
Case ReportsHigh frequency ventilation techniques in ARDS.
High frequency ventilation techniques are not applied as routine measures but are still regarded as lastditch efforts in treating patients with severe ARDS or with extensive bronchoplural fistula when conventional mechanical ventilation is not capable in providing sufficient gas exchange. High frequency ventilation techniques can be used in patients with septicemia or recent cerebral bleeding, which is a contraindication for ECMO, or in patients with increased ICP. We believe that high frequency ventilation techniques provide an important therapeutic tool in the treatment of pulmonary insufficiency since the hardware requirement is minimal and, after a brief explanation, the application is easy.
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Comparative Study Clinical Trial
Effects of different modes of ventilation on right ventricular function in patients with ARDS.
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Peritoneal ventilation has been shown to be effective in achieving extrapulmonary oxygenation and carbon dioxide elimination in an animal model of severe adult respiratory distress syndrome (ARDS). Cisapride is a "prokinetic" agent (increases gastric emptying), that may increase the splanchnic circulation and thus favourably affect gas exchange in peritoneal ventilation. ⋯ Cisapride increases arterial oxygenation in rabbits with severe ARDS treated with peritoneal ventilation, probably due to its ability to increase splanchnic circulation. It should be considered as an adjuvant medication to peritoneal ventilation.
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Total lung capacity (TLC), inspiratory capacity (IC), functional residual capacity (FRC), and deflation pressure-volume (P-V) curves were studied in 16 intubated neonates (540-3300 g), 10 with severe respiratory distress syndrome (RDS) and 6 air-ventilated with normal chest radiograms. FRC was measured using washout of a tracer gas (sulfur hexafluoride), and TLC and IC were calculated after inflating the lungs to 30 cm H2O. P-V curves were obtained during expiration from TLC using an interrupter technique, and the steepest slope of the curve, i.e. the maximum compliance (Crs-max), was calculated. ⋯ The flatter P-V curve in the RDS group was reflected also in a lower Crs-max (median 0.7 and range 0.4-1.7 cm H2O-1 kg-1) than in the air-ventilated group (2.3 and 2.0-3.1 mL cm H2O-1 kg-1, respectively; p < 0.01). Thus, there was no overlap in IC or Crs-max between the groups, suggesting that reductions in these measures may be main characteristics of RDS. On the other hand, no difference in PCD was found, indicating that, in infants with RDS, the tidal volume is distributed fairly homogeneously to the ventilated parts of the lungs.
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This retrospective study of 100 consecutive patients with inhalation injury documents that adult respiratory distress syndrome (ARDS) and pneumonia are common complications. Pulmonary complications cause or directly contribute to death in 77% of patients with combined inhalation and cutaneous burn injury. Additionally, the high fluid requirements of these patients worsens their pulmonary injury and is associated with adverse outcome. ⋯ An abnormal chest roentgenogram in the first 48 hours after injury is also associated with death. The development of ARDS is predicted by the actual volume of fluid resuscitation, despite normal pulmonary wedge pressure or normal central venous pressure reflecting increased microvascular permeability. These findings indicate a need for reevaluation of fluid resuscitation of patients with inhalation injury.