Articles: respiratory-distress-syndrome.
-
In late ARDS, a persistent and exaggerated inflammatory response causes recurrent injury to the alveolocapillary barrier and amplification of intra-alveolar fibroproliferation. When ARDS patients fail to improve, corticosteroid (CS) rescue treatment frequently leads to rapid improvements in lung function. We tested the hypothesis that response to CS treatment is related to suppressing the inflammatory response by comparing changes in lung function to inflammatory cytokine (IC) levels in the plasma and BAL. ⋯ In patients with late ARDS and a low likelihood of survival, prolonged corticosteroid rescue treatment was associated with a reduction in plasma and BAL IC levels and parallel improvements in indices of endothelial permeability and LIS.
-
Pediatric pulmonology · Nov 1995
Clinical Trial Controlled Clinical TrialLong-term pulmonary functional outcome of bronchopulmonary dysplasia and premature birth.
Pulmonary function and exercise tolerance were evaluated in late childhood in two groups of prematurely born children: one group with bronchopulmonary dysplasia (BPD) [n = 15; gestational age at birth (GA): 29.6 +/- 2.8 weeks; birth weight (BW): 1,367 +/- 548 g; age at test: 7.9 +/- 0.6 years], and a second group without significant neonatal lung disease [pre-term (PT)] (n = 9; GA: 30.3 +/- 1.7 weeks; BW: 1,440 +/- 376 g; age at test: 7.8 +/- 0.22 years). The results were compared with a control group of children of similar ages and heights, born at term [term born (TB)]. We observed that total lung resistance (RL) was significantly higher in BPD (11 +/- 3 cmH2O/L/s), and in PT (9 +/- 2) than in TB [5 +/- 1; (P < 0.001 and P < 0.05, respectively)]. ⋯ Exercise tests were performed in six boys with BPD. The ratio between minute ventilation at maximal workload (VEmax) and the predicted value of maximal voluntary ventilation (MVV) was elevated in the six BPD boys tested, compared with five boys of Group 2 and five TB boys (87 +/- 15% vs. 62 +/- 14% and 65 +/- 13%) (P < 0.05). We conclude that: 1) prematurity and BPD is followed by long-term airway obstruction and a mild degree of exercise intolerance and; 2) premature birth without BPD may be followed by a milder degree of airway obstruction in childhood than in infants who developed BPD during the neonatal period.
-
Impairment of cerebrovascular autoregulation may be important in the pathogenesis of ischaemic brain injury in preterm infants. A previous study in ventilated preterm infants paralysed with pancuronium showed that changes in cerebral blood flow velocity (CBFV) were related to concomitant changes in arterial blood pressure. ⋯ These results emphasize the importance of avoiding large swings in blood pressure in paralysed infants. Whether alternative paralysing agents have similar effects warrants further study.
-
Intensive care medicine · Nov 1995
Editorial Comment ReviewWasted efforts and dyssynchrony: is the patient-ventilator battle back?
-
The lung injury score is a semi-quantitative system used in the definition and grading of the acute respiratory distress syndrome. It is composed of two, three or four equally weighted components. One component is derived from the chest radiograph, which may contribute up to 50% of the total score. ⋯ Physician 1 significantly overscored (median score 4). The chest radiograph component of the lung injury score can be consistently assessed by radiologists, but significant variations may be introduced when assessed by other clinicians. This has significant implications for the use of the lung injury score in studies of adult respiratory distress syndrome and other studies which incorporate radiographic appearances in the definition.