Articles: respiratory-distress-syndrome.
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Intensive care medicine · Jan 1990
Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome.
Many animal studies have shown that high peak inspiratory pressures (PIP) during mechanical ventilation can induce acute lung injury with hyaline membranes. Since 1984 we have limited PIP in patients with ARDS by reducing tidal volume, allowing spontaneous breathing with SIMV and disregarding hypercapnia. Since 1987 50 patients with severe ARDS with a "lung injury score" greater than or equal to 2.5 and a mean PaO2/FiO2 ratio of 94 were managed in this manner. ⋯ Only 2 died, neither from respiratory failure. There was no significant difference in lung injury score, ventilator score, PaO2/FiO2 or maximum PaCO2 between survivors and non-survivors. We suggest that this ventilatory management may substantially reduce mortality in ARDS, particularly from respiratory failure.
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Pediatric pulmonology · Jan 1990
Comparative StudyPulmonary function testing prior to extubation in infants with respiratory distress syndrome.
Pulmonary function testing was performed just prior to extubation on 50 infants mechanically ventilated for treatment of respiratory distress syndrome. All infants were ready for extubation as defined by clinical criteria. Pulmonary mechanics and energetics were measured by a computerized technique that consists of a pneumotachometer to measure flow rates and an esophageal balloon and differential transducer to estimate transpulmonary pressure. ⋯ No statistically significant differences in pulmonary mechanics were seen between the two groups. Data suggests that successful withdrawal of mechanical ventilation may be related to multiple factors such as central inspiratory drive, diaphragmatic endurance, and chest wall stability, in addition to improved lung mechanics. Pulmonary function testing criteria alone may not be useful in determining optimal timing of extubation in premature infants.
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Minerva anestesiologica · Jan 1990
Case Reports[ARDS in MOFS (multiple organ failure syndrome). How to direct the therapy? A case report of MOFS in AIDS].
A young AIDS patient was admitted to the Intensive Therapy ward of our hospital with ARDS. The case raised the question of how medical and nursing personnel should face the problem of "suitable treatment for a terminally ill patient". Therapy was based on invasive methods such as mechanical ventilation and the insertion of catheters to monitor vital parameters. The evolution of ARDS in MOFS revealed the difficulty of sustaining vital parameters and avoiding pluriorganic damage.
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Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir · Jan 1990
Review[Acute respiratory distress syndrome of the adult: are there new therapeutic approaches?].
The mortality of adult respiratory distress syndrome (ARDS) remains high despite increasing understanding of the syndrome's pathophysiology, better monitoring and new ventilatory techniques. The outcome can be improved adequate systemic oxygen availability, improved infection control, and biochemical monitoring and interventions. Only by combinating of several treatment modalities is there a reasonable chance to change the prognosis of ARDS.
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Multiple Organ Failure (MOF) has largely been attributed to bacterial sepsis, though conclusive evidence of an essential role for bacteria and/or their endotoxins is still lacking. On the other hand, MOF and the clinical syndrome of sepsis may be aseptically induced in germ-free animals. This paper reviews the evidence that excessive activation of endogenous humoral mediators and inflammatory cells may cause this highly lethal syndrome.