Articles: respiratory-distress-syndrome.
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Intensive care medicine · Aug 1995
Case ReportsInhaled nitric oxide for hemodynamic support after postpneumonectomy ARDS.
Inhaled nitric oxide (NO) has been reported to promote selective pulmonary vasodilation and better arterial oxygenation in cases of adult respiratory distress syndrome (ARDS) with pulmonary hypertension (PHT). However, the clinical relevance of these changes and their effects on outcome remain to be proven, since long-term inhalation carries a potential risk of toxicity. ⋯ NO resulted in better oxygenation and markedly improved hemodynamic status. As the underlying disease progressively worsened the patient became fully dependent on NO for hemodynamic support, and he died after 24 days of effective supportive therapy with inhaled NO.
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Intrapulmonary distribution of a peptide-phospholipid (KL4) surfactant administered through an adapter permitting maintenance of positive end-expiratory pressure was compared with distribution by instillation with disconnection from mechanical ventilation in 10 surfactant-deficient Macaca mullata preterm infants. Animals received KL4 surfactant (200 mg/kg) when the arterial to alveolar (oxygen ratio) (a/Ao2) was < or = 0.22 (approximately 50 min after birth) on mechanical ventilation. Six rhesus infants received bolus instillation of two half doses of KL4 surfactant through an endotracheal tube adapter over 10-15 s while maintaining positive end-expiratory pressure (0.4 kPa) accompanied by turning to the right and left lateral positions for 60 s. ⋯ Intrapulmonary distribution of KL4 surfactant was determined using dye-labeled microspheres or [3H]dipalmitoylphosphatidylcholine-labeled surfactant, measured by colorimetry or by scintillation counting. Lungs of each monkey were processed into 50 +/- 5 pieces to determine distribution of radiolabel or microspheres and for scanning electron microscopy. The drop in oxygen saturation was greater among monkey infants disconnected from the ventilator for surfactant instillation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Intensive care medicine · Jul 1995
Review Case ReportsLow blood flow extracorporeal carbon dioxide removal (ECCO2R): a review of the concept and a case report.
Despite advances in respiratory and critical care medicine, the mortality from ARDS remains unchanged. Recent research suggests current ventilatory therapy may produce additional lung injury, retarding the recovery process of the lung. ⋯ Low flow ECCO2R may offer advantages of less invasiveness and be suitable for early institution before ARDS becomes irreversible. We describe a patient with ARDS and severe macroscopic barotrauma supported with low flow ECCO2R resulting in significant CO2 clearance, reduction of peak, mean airway pressures and minute ventilation.
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Comparative Study
Clinical and financial outcomes of lateral rotation low air-loss therapy in patients in the intensive care unit.
To determine the clinical impact and cost-effectiveness of two lateral rotation low air-loss therapy beds and their supporting protocols in the treatment of critically ill patients. ⋯ In this study, patients treated by a prevention protocol with the Restcue beds (Support Systems International, Inc., Charleston, S.C.) had better clinical and financial outcomes than patients treated on Biodyne beds (Kinetic Concepts, Inc., San Antonio, Texas) with a more restricted, cost-conscious protocol aimed primarily at patients who have or who are at a higher risk for severe pneumonia, presence of septic shock, or adult respiratory distress syndrome.