Articles: respiratory-distress-syndrome.
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Journal of critical care · Mar 1994
ReviewReport of the American-European Consensus conference on acute respiratory distress syndrome: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Consensus Committee.
The acute respiratory distress syndrome (ARDS), a process of nonhydrostatic pulmonary edema and hypoxemia associated with a variety of etiologies, carries a high morbidity rate, mortality rate (10% to 90%), and financial cost. The reported annual incidence in the United States is 150,000 cases, but this figure has been challenged and may be different in Europe. ⋯ The European American Consensus Committee on ARDS was formed to focus on these issues and on the pathophysiologic mechanisms of the process. It was felt that international coordination between North America and Europe in clinical studies of ARDS was becoming increasingly important to address the recent plethora of potential therapeutic agents for the prevention and treatment of ARDS.
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The onset of agitation and distress in a mechanically ventilated patient should initiate a careful assessment that considers whether there has been progression of the underlying disease, a new medical complication, or adverse effects from medical interventions and procedures, including intubation and mechanical ventilation. This article focuses on problems that relate to mechanical ventilation and the interactions of the "patient-ventilator system". The authors suggest an initial approach to the patient who develops respiratory distress, and then review the appropriate indications for sedative and paralytic medications.
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Randomized Controlled Trial Clinical Trial
Flow-synchronized ventilation of preterm infants with respiratory distress syndrome.
Asynchrony of delivered and spontaneous breaths in mechanically ventilated infants may impair gas exchange and prolong the need for assisted ventilation. We conducted a randomized, controlled trial of a patient-triggered, flow-synchronized ventilator on 30 preterm infants with respiratory distress syndrome who weighed between 1100 and 1500 gm at birth. Entry criteria included radiographic evidence of respiratory distress syndrome and the need for mechanical ventilation and surfactant replacement therapy. ⋯ Patients treated with flow-synchronized ventilation were weaned more rapidly and had a significantly shorter mean time to extubation than those treated with time-cycled, pressure-limited ventilation, 119 versus 271 hours, p = 0.0152. In addition, there was no difference in the rate of complications between the two groups. There were, however, considerable reductions in patient charges of $4344 per patient in the flow-synchronized ventilation group.
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Toxic inhalants cause injury through a variety of different mechanisms, including direct irritation of the respiratory tract mucosa, asphyxiation, and systemic absorption of the toxin. The nature and extent of the acute injury depends on the inhalant's water solubility, aerodynamic features, pH, and concentration. In addition, a patient's underlying respiratory function may affect the clinical response. ⋯ Chronic airflow obstruction has been reported in patients exposed to ammonia, chlorine, nitrogen dioxide, and sulfur dioxide; bronchiolitis obliterans may follow exposure to nitrogen dioxide and sulfur dioxide. Inhalation injuries can be difficult to manage because exposures occur infrequently, and the exact toxic agents involved often are not known immediately. Prevention of occupational exposures remains a cornerstone in the overall management of inhalation injuries.