Articles: respiratory-distress-syndrome.
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Comparative Study Clinical Trial
Evaluation of oxygenation with different modes of ventilation in patients with adult respiratory distress syndrome.
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Annual review of medicine · Jan 1992
ReviewPrinciples of mechanical ventilator use in respiratory failure.
Recent advances in our knowledge of the pathophysiology of acute and chronic respiratory failure have significantly revised our strategies for ventilatory support. Gas exchange, muscle function, barotrauma, and the course and prognosis of the mechanically ventilated patient are now better understood. Furthermore, impressive technological innovations have enabled the clinician to monitor patient-ventilator interactions closely and to undertake ventilatory approaches unthought of only a short time ago. The purpose of this review is to highlight key management principles and therapeutic options that derive from our improved understanding of respiratory failure and its treatment.
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Pulmonary arterial hypertension, defined as a mean pulmonary artery pressure exceeding 20 mmHg has been observed both in experimental animal and human sepsis, even before development of the adult respiratory distress syndrome. In this article we review several mechanisms that have been invoked for the pulmonary arterial hypertension associated with sepsis (and the adult respiratory distress syndrome): obstruction of the pulmonary microcirculation with microthrombi composed of platelets and leukocytes, and active pulmonary vasoconstriction induced by the autonomous nervous system, hypoxia or vasoactive humoral factors ("mediators"). Some of these mediators, in particular serotonin and arachidonic acid metabolites have been the subject of substantial research and therapeutic manipulation. Since pulmonary arterial hypertension imposes an increased afterload to the right ventricle and because right ventricular dysfunction appears to be a major determinant of the outcome of sepsis, the study of the mechanisms involved in pulmonary arterial hypertension may lead to improved management of sepsis and septic shock.
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Eur J Cardiothorac Surg · Jan 1992
Case ReportsMajor thoracic surgery during long-term extracorporeal lung assist for treatment of severe adult respiratory distress syndrome (ARDS).
Surgery in patients treated with extracorporeal lung assist (ELA) carries a high risk of life threatening bleeding complications caused by the need for systemic anticoagulation. A case report describing a successful surgical intervention for the repair of a broncho-pleural leakage by thoracotomy during ELA is presented. ⋯ The heparin coated system allowed discontinuation of systemic heparinization intraoperatively without coagulation complications related to the extracorporeal system. This procedure was followed by resolution of the ARDS.
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Intensive care medicine · Jan 1992
Comparative StudyAn experimental randomized study of five different ventilatory modes in a piglet model of severe respiratory distress.
To characterize different modes of pressure- or volume-controlled mechanical ventilation with respect to their short-term effects on oxygen delivery (DO2). Furthermore to investigate whether such differences are caused by differences in pulmonary gas exchange or by airway-pressure-mediated effects on the central hemodynamics. ⋯ In this model, as far as oxygenation is concerned, it does not matter in which specific way the airway pressures are produced. As far as oxygen transport is concerned, i.e. aiming at increasing DO2, we conclude that optimizing the circulatory status must take into account the circulatory influence of different modes of positive pressure ventilation.