Articles: respiratory-distress-syndrome.
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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.
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Monaldi Arch Chest Dis · Jun 1994
Randomized Controlled Trial Clinical TrialVolume-controlled ventilation and pressure-controlled inverse ratio ventilation: a comparison of their effects in ARDS patients.
Volume-controlled ventilation with positive end-expiratory pressure (PEEP) (CPPV) is the conventional ventilatory approach in adult respiratory distress syndrome (ARDS) patients, but some reports suggest that pressure-controlled ventilation with an inverse inspiratory to expiratory ratio (PCIRV) may improve gas exchange in these patients. We analysed the acute effects on gas exchange, lung mechanics and haemodynamics induced by CPPV and PCIRV in ARDS patients. CPPV and PCIRV were applied randomly in ARDS patients. ⋯ Oxygen transport and total respiratory system compliance remained unchanged in both modes. Mean Paw was slightly lower during CPPV (17 +/- 1 cmH2O) than during PCIRV (19 +/- 1 cmH2O). PCIRV does not appear to have clinical advantages over CPPV in terms of gas exchange, haemodynamics, or static lung mechanics when using the same total PEEP and minute ventilation.
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The Journal of pediatrics · Jun 1994
Acute effects of inhaled nitric oxide in children with severe hypoxemic respiratory failure.
To determine the physiologic effects of inhaled nitric oxide (NO) on oxygenation and hemodynamics in children with severe hypoxemic respiratory failure, we studied the acute response to inhaled NO during mechanical ventilation in 17 pediatric patients. Diagnoses included adult respiratory distress syndrome (ARDS) (10 patients), bronchopulmonary dysplasia with viral pneumonitis (6 patients), and acute pneumonitis, caused by respiratory syncytial virus, without chronic lung disease (1 patient). Gas exchange and hemodynamic measurements were compared before and during exposure to inhaled NO (20 ppm) without changing ventilator settings for 30 minutes. ⋯ Fifteen patients were subsequently treated with low-dose inhaled NO (3 to 10 ppm) for 1 to 24 days; 5 (50%) of 10 patients with ARDS and 7 (100%) of the 7 non-ARDS patients survived. We conclude that inhaled NO acutely improves oxygenation and lowers pulmonary vascular resistance without causing adverse hemodynamic effects in severe hypoxemic respiratory failure in pediatric patients. Inhaled NO may be a useful adjuvant therapy in children with acute hypoxemic respiratory failure, including infants with bronchopulmonary dysplasia, but whether prolonged low-dose inhalational NO therapy can reduce morbidity or improve survival rates remains unknown.