Articles: respiratory-distress-syndrome.
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Twelve patients with the adult respiratory distress syndrome were included in this study and evaluated by transesophageal echocardiography and Doppler, assessing right and left ventricular intracardiac blood flow alterations with progressive increase of inspiration-to-expiration (I-E) ratios. Whereas midpulmonary artery flow parameters did not show any change, early left ventricular filling demonstrated a significant increase after switching the ventilatory mode from volume to pressure-controlled ventilation with 2:1 I-E ratio (end-inspiration: 39 +/- 26 cm with positive end-expiratory pressure [PEEP]-ventilation to 68 +/- 56 cm with pressure-controlled inverse-ratio ventilation, 2:1; p < 0.01; at end-expiration, from 67 +/- 21 cm with PEEP-ventilation to 83 +/- 36 cm with pressure-controlled ventilation 1:1; p < or = 0.05), resulting probably from different ventilatory flow and pressure curves. In the meanwhile, cardiac index demonstrated a significant augmentation (from 4.73 +/- 1.71 L/min.m2 to 5.56 +/- 1.66 L/min.m2; p < 0.05). Pressure-controlled inverse ratio ventilation results in both respiratory and hemodynamic advantages as is demonstrated by this study.
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The Journal of pediatrics · Jul 1993
Adult respiratory distress syndrome in children: associated disease, clinical course, and predictors of death.
The adult respiratory distress syndrome is a common cause of respiratory failure; however, its incidence, risk factors, course, and mortality rate for children remain incompletely understood. A 24-month surveillance of pediatric intensive care admissions identified 60 children with adult respiratory distress syndrome constituting 2.7% of such admissions, 8% of total days spent in a pediatric intensive care unit, and 33% of deaths. The mortality rate was 62% (confidence interval, 48.2% to 73.9%). ⋯ An alveolar-arterial oxygen tension difference > 420 was the best early predictor of death (sensitivity 80%, specificity 87%, positive predictive value 87%, negative predictive value 80%, and odds ratio 26.7). We conclude that adult respiratory distress syndrome behaves clinically as a single disease regardless of the underlying cause; its course and outcome are dependent on the magnitude of alveolar injury. We speculate that strategies for minimizing secondary lung injury may benefit all patients with adult respiratory distress syndrome.
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The authors have developed a venovenous extracorporeal lung support technique with an original single lumen cannula to avoid the carotid ligation of venoarterial extracorporeal membrane oxygenation (ECMO). During a 5 year period, the authors have used the technique in 107 neonates (weight: 3.045 +/- 0.6 1 kg; gestational age: 38.1 +/- 2.2 weeks). All of the neonates had severe respiratory failure despite maximal conventional treatment and the same indications as those for ECMO. ⋯ The mean duration of bypass was 117.8 +/- 83.9 hr, and 91 of the 107 (85%) neonates were weaned from AREC. The technical complications were less important than those associated with venoarterial ECMO. The authors conclude that AREC is as effective as venoarterial ECMO and is easier to use.
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Critical care medicine · Jul 1993
Intratracheal perfluorocarbon administration combined with mechanical ventilation in experimental respiratory distress syndrome: dose-dependent improvement of gas exchange.
To test the efficacy of intratracheal instillation of a perfluorocarbon, combined with conventional mechanical ventilation, as well as to establish the dose response of this application on pulmonary parameters in adult animals with acute respiratory failure. ⋯ The remarkable improvements in pulmonary parameters suggest that this type of ventilatory support offers an effective and simple method of perfluorocarbon application in acute respiratory failure.
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The time-course of volume change during passive expiration preceded by an end-inspiratory hold was studied with a biexponential model in six adult respiratory distress syndrome (ARDS) patients. We measured the initial volumes and time constants of the fast (tau 1), and the slow (tau 2) compartments of expiration, as well as the static elastance of the respiratory system. ⋯ We observed that: 1) the biexponential model fitted closely the volume decay; 2) the fast compartment was responsible for 81 +/- 7% (ARDS) versus 84 +/- 10% (controls) of the total volume exhaled, with tau 1 = 0.35 +/- 0.11 s (ARDS) versus 0.50 +/- 0.22 s (controls); 3) the slow compartment contributed only 19 +/- 6% (ARDS) versus 16 +/- 7% (controls), with tau 2 = 4.67 +/- 2.38 s (ARDS) versus 3.27 +/- 1.54 s (controls); and 4) static elastance was higher in ARDS patients. The findings could be explained in terms of a four parameter viscoelastic model of the respiratory system.