Articles: respiratory-distress-syndrome.
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Critical care medicine · Jun 1993
Randomized Controlled Trial Clinical TrialEffect of maximizing oxygen delivery on morbidity and mortality rates in critically ill patients: a prospective, randomized, controlled study.
To determine the effects of optimizing oxygen delivery (DO2) to "supranormal" levels on morbidity and mortality in patients with sepsis, septic shock, and adult respiratory distress syndrome. ⋯ Although there was no statistically significant difference in the control vs. treatment groups, subgroup analysis demonstrated a strong, significant difference between patients with supranormal values of oxygen transport vs. patients with normal levels of DO2. Supranormal values of DO2I, whether self-generated or as a result of treatment, resulted in a statistically significant decrease in mortality rate. This study adds to the weight of evidence that current standard of care of treating critically ill patients to normal DO2I should be reconsidered, and that maximizing to high DO2I might be a more appropriate therapeutic end-point.
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Klinische Pädiatrie · May 1993
Randomized Controlled Trial Clinical Trial[Effect of body position and positioning changes on lung function of ventilated premature and newborn infants].
We studied 21 intubated premature infants (wts 800-2800 g) with respiratory distress syndrome between day 2 and 10 to evaluate the effect of body position on lung mechanics and gas exchange. The dynamic compliance of the total respiratory system was similar in the prone and supine position. ⋯ Positioning did not significantly affect the dynamic compliance, the minute volume or pCO2. In circulatory stable premature infants a change of the body position probably alters the regional ventilation to perfusion ratio and leads to a reduction of intrapulmonary venous admixture.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomised trial of methods of extubation in acute and chronic respiratory distress.
Sixty infants (median gestational age 29 weeks) with acute and 60 infants (median gestational age 25 weeks) with chronic respiratory distress were randomised to be extubated either directly into a headbox or onto 3 cm H2O nasal continuous positive airway pressure (CPAP). Our aim was to test the hypothesis that extubation onto nasal CPAP rather than directly into a headbox was more likely to be associated with successful extubation in infants with acute rather than chronic respiratory distress. Overall the failure rate of extubation was approximately 33%, with no significant difference between the infants with acute and chronic respiratory distress. There was no significant difference in the failure rate of extubation among infants randomised to receive nasal CPAP or headbox oxygen in either the acute or chronic respiratory distress groups.
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In the 25 yrs since the original description of adult respiratory distress syndrome, much has been learned concerning the pathology and pathophysiology of the syndrome. Investigations into the humoral mediator of the syndrome are proceeding. Despite these advances and the advances in intensive care medicine, adult respiratory distress syndrome remains a considerable clinical challenge, especially when associated with sepsis.