Articles: respiratory-distress-syndrome.
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Critical care medicine · May 1991
Use of continuous noninvasive measurement of oxygen consumption in patients with adult respiratory distress syndrome following shock of various etiologies.
To describe the patterns of cardiac index, oxygen delivery (DO2), oxygen consumption (VO2), and oxygen deficit (or excess) and to compare invasive and noninvasive monitoring systems for evaluation of these oxygen transport patterns. ⋯ Monitoring of VO2 and DO2 variables is useful for evaluation of tissue oxygenation and titration of therapy in critically ill patients. Noninvasive monitoring of VO2 values are in good agreement with VO2 values calculated from invasive measurements of cardiac index. The increased DO2 and VO2 values are not attributable to mathematical coupling of erroneous cardiac index values.
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Several studies have reported significant improvement in arterial blood oxygenation with use of the prone position in ARDS. This study, undertaken to examine the effect of the semi-prone position in patients with ARDS, resulted in several important considerations for clinical nursing practice.
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During continuous positive pressure ventilation (CPPV), mean airway pressure and lung volume will be influenced both by the tidal volume (VT) employed and the amount of positive end-expiratory pressure (PEEP). The effect of varying levels of CPPV on PaO2 and cardiac output (Q) has been previously assessed by adjusting the level of PEEP at constant VT. This study examined the influence of a 200-ml reduction in VT, at a constant PEEP of 15 cm H2O, on the PaO2 and Q of 21 patients with adult respiratory distress syndrome (ARDS). ⋯ Cst increased with VT reduction (+ 3.1 +/- 1.8 ml/cm H2O). There was only a modest correlation (r = +0.42, p = 0.06) between delta Q percent and delta Cst following VT reduction. VT reduction at high level PEEP may yield a significant improvement in Q and net O2 delivery, but the degree of hemodynamic improvement is variable and is not reliably predicted noninvasively by measurement of Cst.
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Early human development · May 1991
Spontaneous respiratory effort during mechanical ventilation in infants with and without acute respiratory distress.
Respiratory interactions of 27 ventilated preterm infants were recorded daily during the first 14 days of life to assess the effect on respiratory efforts of recovery from acute respiratory distress syndrome (RDS). Active expiration and persistent asynchrony only occurred during acute RDS (P less than 0.01). Throughout the 14-day period, in the majority of infants making respiratory efforts, a ventilator rate could be found from a standard sequence 30, 60, 90, 120 breaths/min which provoked a synchronous interaction, but with increasing postnatal age apnoea became more common (P less than 0.01). We conclude that the preterm infants' spontaneous respiratory efforts are a less important influence on the outcome of mechanical ventilation following recovery from acute RDS.
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The Journal of pediatrics · Apr 1991
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialRandomized, placebo-controlled trial of human surfactant given at birth versus rescue administration in very low birth weight infants with lung immaturity.
A randomized, placebo-controlled trial of human surfactant given intratracheally at birth (prophylactic) versus rescue administration after the onset of severe respiratory distress syndrome (RDS) was conducted among preterm infants born at 24 to 29 weeks of gestation. Singleton fetuses were randomly assigned to receive (1) placebo (air), (2) prophylactic surfactant treatment, or (3) rescue surfactant treatment; infants of multiple births received either (1) prophylactic or (2) rescue treatment. Of 282 potentially eligible fetuses, 246 infants received treatments at birth and 200 infants had RDS. ⋯ Among infants with RDS, the total mortality rate was significantly improved (p = 0.004) with surfactant treatment but not the proportion alive and without bronchopulmonary dysplasia at 28 days (p = 0.052), or the proportion alive and without bronchopulmonary dysplasia at 38 weeks of postconceptional age (p = 0.18) to adjust for differences in prematurity. Deaths caused by RDS or bronchopulmonary dysplasia were significantly reduced among surfactant recipients (p = 0.0001). Neither among singletons nor among multiple-birth infants was there a selective advantage to prophylactic versus rescue treatment.(ABSTRACT TRUNCATED AT 400 WORDS)