Articles: respiratory-distress-syndrome.
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Extracorporeal carbon dioxide removal (ECCO2-R) over a membrane lung is a new therapy for patients with adult respiratory distress syndrome (ARDS) who frequently suffer from lung complications caused by long-term artificial ventilation and who may require major thoracic surgery. This is a report of 76 patients with severe ARDS who were treated by ECCO2-R. Twenty-six of these 76 patients required thoracotomy: 19 for pneumothorax and pneumatocele, and seven for haemothorax, infected lung necrosis or oesophagotracheal fistula. ⋯ Ten of these 26 patients required reoperation, usually for extensive persisting alveolar air leaks. Sixteen (62 per cent) of the 26 patients who had a thoracotomy and 22 (44 per cent) of the 50 patients without surgery survived. These results demonstrate that performing a thoracotomy, if necessary, does not diminish the survival chance of high-risk patients with severe ARDS.
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Clinics in chest medicine · Dec 1990
ReviewLung mechanics in the adult respiratory distress syndrome. Recent conceptual advances and implications for management.
Since the earliest description of the adult respiratory distress syndrome (ARDS), impaired lung compliance has been a key diagnostic feature. Newer data suggest that a clear understanding of the mechanisms of acute lung injury may be needed to select the ventilatory pressures and patterns of flow delivery required for optimal gas exchange, adequate oxygen supply to tissue, and avoidance of barotrauma. This discussion briefly reviews the ARDS-specific derangements of lung mechanisms, describes measurement techniques applicable to the clinical setting, and suggests ways in which such information can be used in patient management.
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Anasth Intensivther Notfallmed · Dec 1990
[The measurement of extravascular lung water--significant in the follow-up of ARDS?].
In 40 adult patients suffering from severe ARDS stage III and IV (Morel) we examined the course of the extravascular lung water (EVLW) measured by the double indicator dilution method with 858 single measurements, during mechanical ventilation with PEEP, or extracorporeal CO2 elimination (ECCO2 R). No correlation could be found between EVLW and the values of alveolar arterial oxygen difference (AaDO2) and intrapulmonary right-left shunt (Qs/Qt) or haemodynamic values such as CVP, PCWP, mean pulmonary arterial pressure, or the 24 h fluid balance. It was, therefore, not possible to estimate a prognostic trend based on a single measurement of EVLW. ⋯ However, during the ECCO2-R treatment the repeated estimation of EVLW and AaDO2 is a useful tool to assess recovery because other parameters such as Qs/Qt and chest computer tomography during long-term bypass are very difficult or impossible to employ for this purpose. A change of EVLW with increasing PEEP level could not be found. The reproducibility of 858 EVLW values was excellent with a coefficient of variation of 4.9 +/- 3.5%.
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In cancer patients, respiratory distress may be due to cancer directly, to cancer complications, to cancer treatment complications or unrelated diseases. Based on the identification of the mechanism and cause of the dyspnea, therapy that will be given in a critical care unit, will be both etiological and supportive. It will take into account the prognosis of the underlying neoplastic disease.
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The adult respiratory distress syndrome developing within 24 hours in a patient who underwent suction lipectomy for body contouring under general anaesthesia is reported. During surgery, in which a total of 1.3 l of suction matter was removed, the patient became haemodynamically unstable and mildly hyperthermic. Subsequently, clinical signs and symptoms of the fat embolism syndrome developed. ⋯ Malignant hyperthermia was excluded as cause for the clinical presentation on muscle biopsy and in vitro caffeine contracture studies. Although usually complication-free, suction lipectomy may be associated with life-threatening incidents. Even suction volumes as low as 1.3 l have potential hazards, therefore the procedure merits regular postoperative observation and re-assessment.