Articles: respiratory-distress-syndrome.
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In 1970s, survival rate in patients undergoing extracorporeal membrane oxygenation (ECMO) for acute respiratory failure was some around 10% even in sophisticated institutions. Most of them were treated by veno-arterial bypass along with mechanical ventilation with high air way pressure. Problems seen in this treatment modality were; difficulty in controlling bleeding and superimposed infection, mechanical problems of equipment (membrane lung, pumps, bypass circuit etc.), inadequate understanding of pathophysiology of respiratory failure. ⋯ Successful cases are seen in younger patients with short duration of respiratory failure with reversible lung diseases. Bypass time is shorter in successful cases than that in unsuccessful cases. ECMO has revisited as Bartlett says.
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Conventional treatment of the adult respiratory distress syndrome (ARDS) includes pressure-limited ventilation, permissive hypercapnia, posture changes, aggressive dehydration, selective lung ventilation, and extracorporeal gas exchange. New strategies such as nitric oxide inhalation, the implantation of an intravenous membrane oxygenator (IVOX), and surfactant replacement are currently under evaluation. Nitric oxide (NO) is an important endothelium-derived relaxing factor that is rapidly inactivated by binding to haemoglobin. ⋯ Furthermore, the surfactant surface tension-lowering activity is abnormal. Thus, administration of exogenous surfactant may have therapeutic benefits. However, the optimal surfactant preparation, the optimal amount required to restore lung surfactant activity, and the optimal method to deliver it to patients with ARDS are unknown and currently under evaluation.
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Adult respiratory distress syndrome (ARDS) is a critical medical problem in which severe arterial hypoxemia is often poorly responsive to conventional modes of mechanical ventilation. We studied the efficiency of mechanical ventilation of the peritoneal cavity in rabbits with experimental ARDS caused by lung lavage. The study shows that peritoneal ventilation is significantly effective in oxygenation of hypoxemic animals with ARDS and is also effective for carbon dioxide elimination. Peritoneal ventilation may be considered as an investigational method for extrapulmonary oxygenation in severe intractable hypoxemia caused by ARDS.