Articles: respiratory-distress-syndrome.
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Revista médica de Chile · Jan 1996
[Extracorporeal respiratory assistance. Experience in the treatment of severe acute respiratory failure].
Acute respiratory distress syndrome (ARDS) secondary to systemic injury has a high mortality. Symptomatic treatment with mechanical ventilation, PEEP and high levels of inspired oxygen is effective for most of the patients. When ventilatory support fails in reversing hypoxemia, extracorporeal respiratory assistance has been advocated as a temporary treatment until lung repair occurs. ⋯ Extracorporeal assistance was maintained for 52 +/- 34 h (19-134). Five (45%) patients were weaned off the pump and two (18%) survived and were discharged. Despite the high cost, extracorporeal respiratory assistance, when applied to selected patients, can reverse hypoxia and may save some previously unsalvagable patients, allowing them to return to a normal life.
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Late acute respiratory distress syndrome (ARDS), characterized by progressive pulmonary interstitial fibroproliferation, is associated with mortality > 80%. Although previous large prospective trials failed to show a benefit of steroids in early ARDS, recent small reports describe improved survival in patients with late ARDS. Recognizing the pathogenetic differences between early and late ARDS, we employed steroid therapy in patients with refractory late ARDS. ⋯ Steroid therapy appears to be effective in patients with refractory late ARDS. Prospective trials are needed to define the indications, timing of intervention, dose and duration, and precautions of steroid therapy.
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Am. J. Respir. Crit. Care Med. · Dec 1995
Randomized Controlled Trial Clinical TrialBeneficial effects of the "open lung approach" with low distending pressures in acute respiratory distress syndrome. A prospective randomized study on mechanical ventilation.
Alveolar overdistention and cyclic reopening of collapsed alveoli have been implicated in the lung damage found in animals submitted to artificial ventilation. To test whether these phenomena are impairing the recovery of patients with acute respiratory distress syndrome (ARDS) submitted to conventional mechanical ventilation (MV), we evaluated the impact of a new ventilatory strategy directed at minimizing "cyclic parenchymal stretch." After receiving pre-established levels of hemodynamic, infectious, and general care, 28 patients with early ARDS were randomly assigned to receive either MV based on a new approach (NA, consisting of maintenance of end-expiratory pressures above the lower inflection point of the P x V curve, VT < 6 ml/kg, peak pressures < 40 cm H2O, permissive hypercapnia, and stepwise utilization of pressure-limited modes) or a conventional approach (C = conventional volume-cycled ventilation, VT = 12 ml/kg, minimum PEEP guided by FIO2 and hemodynamics and normal PaCO2 levels). ⋯ After correcting for baseline imbalances in APACHE II, we observed a higher weaning rate in NA (p = 0.014) but not a significantly improved survival (overall mortality: 5/15 in NA versus 7/13 in C, p = 0.45). We concluded that the NA ventilatory strategy can markedly improve the lung function in patients with ARDS, increasing the chances of early weaning and lung recovery during mechanical ventilation.