Articles: respiratory-distress-syndrome.
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In order to determine if the Adult Respiratory Distress Syndrome (ARDS) is associated with a shortage of pulmonary surfactant, we have examined a series of 155 undiluted tracheal aspirates obtained from 23 patients with ARDS and from 30 patients without ARDS, all 53 needing ventilatory support. The unfixed and unstained specimens were examined by polarized light microscopy for the presence of pulmonary surfactant. Free surfactant particles were present in the aspirates of 50 patients (95%). ⋯ Fibrinogen/fibrin was found in the aspirates from 20 of 21 patients with ARDS and in only five of 30 patients without ARDS; these five had bronchopneumonia. The method has a sensitivity of 0.95 and a specificity of 0.83. The role of plasma proteins and of neutrophil leucocytes in causing ARDS is discussed.
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We describe a case of severe acute lung injury after attempted strangulation. The patient presented initially with cerebral irritability and florid, noncardiogenic pulmonary oedema which were followed by a prolonged period of the adult respiratory distress syndrome, severe sepsis and multiple system organ failure, although the patient eventually survived. The pulmonary injury following strangulation is proposed to be a result of the generation of marked subatmospheric pressures within the lungs during vigorous inspiration against an obstructed airway, although the processes involved in the so-called neurogenic pulmonary oedema are difficult to exclude.
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Am. Rev. Respir. Dis. · May 1993
Four markers of collagen metabolism as possible indicators of disease in the adult respiratory distress syndrome.
During the adult respiratory distress syndrome (ARDS), an irreversible fibrotic process can occur extremely rapidly. To establish indices of ARDS in pneumonia as well as the severity of the lung fibrosis, we have undertaken for the first time a study of four markers of collagen metabolism obtained from both bronchoalveolar lavage fluid (BALF) and serum: Type I (CI), Type III (CIII), N-terminal peptide of Type III procollagen (PIIINP), and galactosylhydroxylysylglucosyltransferase activity (GGT). We studied 61 patients (13 coma controls, 29 with pneumonia, and 19 with ARDS). ⋯ Molecular mass determinations demonstrated that CI- and CIII-related antigens in BALF were essentially intact triple helices of collagens or procollagens. Among patients with histologically defined interstitial fibrosis, the level of PIIINP in BALF was significantly higher for those with an additional intraalveolar fibrosis. In conclusion, measurements of these collagen markers may be useful for assessing disease activity and reflecting the flux of collagen molecules in the lung.
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Pediatric pulmonology · May 1993
Response to added dead space in ventilated preterm neonates and outcome of trial of extubation.
The ventilatory response to an added external dead space was assessed in preterm babies, recovering from respiratory distress syndrome, immediately prior to extubation. All babies were ready for extubation as defined by routine clinical criteria. Baseline measurements of respiratory rate, tidal volume, and minute ventilation were made over a 2 min period using a computerized system consisting of a pneumotachometer connected directly to the proximal end of the endotracheal tube. ⋯ Extubation success and failure groups were compared by expressing the minute ventilation after addition of the external dead space as a percentage of the baseline minute ventilation (%MV1). Successful extubation was associated with a higher median %MV1 compared with babies who failed extubation (156; range, 89.3 to 230; compared to 131; range, 75.2 to 165; P = 0.006). This test may be useful in deciding which babies could be successfully extubated.
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The purpose of this study is to describe an unexpected degree of differences between expiratory occlusion plateau pressure (EPO) and airway opening pressure (Pawo) measured level of intrinsic positive end-expiratory pressure above externally applied (auto-PEEP) that was found in six critically ill patients. In six patients (ten studies), the presence and degree of auto-PEEP found during the EPO maneuvers was not confirmed by Pawo measurements. ⋯ Because of the static nature of the EPO determination, a rise in pressure could conceivably be caused by the presence of subcutaneous or mediastinal emphysema and retrograde flow across the airway defect during exhalation. We suggest another cause for auto-PEEP-dynamic hyperinflation from extrapulmonary flow limitation.