Articles: respiratory-distress-syndrome.
-
Randomized Controlled Trial Clinical Trial
Progress in veno-venous long-term bypass techniques for the treatment of ARDS. Controlled clinical trial with the heparin-coated bypass circuit.
Extracorporeal CO2 removal combined with low-frequency positive pressure ventilation (ECCO2-R LFPPV) is a new therapeutic approach in treatment of ARDS. The main problem during long-term extracorporeal support is anticoagulation and related bleeding problems. ⋯ Bleeding complications were less and more patients survived in group 2. The disadvantage of the hollow fiber oxygenators in the heparin-coated system was plasma leakage, which was more frequent in patients with pancreatitis and hyperbilirubinemia.
-
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.
-
The influence of postnatal age on spontaneous respiratory time, measured both on and off continuous positive airways pressure (CPAP), and the occurrence of the Hering Breuer reflex has been investigated. Consecutive ventilated infants were recruited and only studied when making respiratory efforts during mechanical ventilation. Fifty-three infants were studied on 119 occasions, their median gestational age was 29 weeks and birthweight 1142 gms. ⋯ No influence of postnatal age was demonstrated on the proportion of infants in whom the Hering Breuer reflex was demonstrated. Our results suggest that, during the neonatal period, there is no influence of postnatal age on respiratory timings or reflex activity amongst ventilated infants who make spontaneous respiratory efforts during ventilation. These results have important implications regarding the optimum rate at which such infants should be ventilated.