Articles: respiratory-distress-syndrome.
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Pediatric pulmonology · Jan 1991
Effect of positive end-expiratory pressure on respiratory compliance in children with acute respiratory failure.
We studied the effect of positive end-expiratory pressure (PEEP) on the compliance of the respiratory system (Crs) in 25 children (age, 3 weeks to 10 years) requiring mechanical ventilation. Functional residual capacity (FRC) measurements were performed at 2 cm H2O increments, from 0 to 18 cm H2O of PEEP, and the FRC values were regressed versus PEEP. Static Crs, Crs/kg, and specific compliance (Crs/FRC) were calculated for each PEEP level. ⋯ We concluded that static respiratory compliance improves in most (but not all) children with acute respiratory failure when FRC is normalized. Static respiratory compliance reaches maximum levels at PEEP values that are close (but not equal) to those that result in FRC normalization. Thus, assessment of the effect of PEEP on compliance is required in individual patients.
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Acta Anaesthesiol Scand Suppl · Jan 1991
Extracorporeal carbon dioxide removal performed with surface-heparinized equipment in patients with ARDS.
To avoid the drawbacks of systemic anticoagulation during prolonged extracorporeal circulation in patients with adult respiratory distress syndrome (ARDS) a heparinization technique has been developed by which partially degraded heparin can be covalently end-point attached to the surface of the equipment constituting the extracorporeal circuit (Carmeda Bio-Active Surface, CBAS) thereby localizing the anticoagulatory effect. Since 1986 we have used extracorporeal circuits and membrane lungs coated with the CBAS for extracorporeal lung assistance (ECLA) in 14 patients suffering from ARDS. The patients were on ECLA for 3 to 55 days with a survival rate of 43%. Our experience so far is that by using equipment coated with CBAS it is possible to perform long-term extracorporeal circulation with a minimum of intravenously administered heparin, thus avoiding the risk of major coagulation defects.
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Clinics in chest medicine · Dec 1990
ReviewVentilatory strategies in the management of the adult respiratory distress syndrome.
This article review available strategies for mechanically ventilating patients with the adult respiratory distress syndrome. The authors first present the conventional strategies of mechanical ventilation: volume-limited mechanical ventilation with positive end-expiratory pressure (PEEP) at normal inspiratory-expiratory ratios, the approach that has been the mainstay of ventilatory support since the initial description of PEEP. This discussion attempts to summarize the rationale and goals of treatment in a practical, clinically useful manner. The second section of the article reviews less conventional ventilatory approaches, including inverse ratio ventilation, extracorporeal techniques, high-frequency ventilation, prone position, and fluctuating PEEP, and attempts to review critically the available literature regarding their application.