Articles: respiratory-distress-syndrome.
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Anasth Intensivther Notfallmed · Oct 1989
[Acute respiratory distress syndrome of the adult (ARDS) and artificial respiration--results in surgical intensive care patients].
A prospective clinical trial was performed in an operative intensive care unit to examine the incidence and outcome of patients with adult respiratory distress syndrome (ARDS) and the outcome of intensive care patients on mechanical ventilation and the incidence of barotrauma and pulmonary infection. 161 mechanically ventilated patients showed an overall mortality of 19.9%. The mortality rate in the ARDS patients was 11 of 26. Most of these patients with ARDS died from multiorgan failure. ⋯ We conclude from these data that --according to the literature the outcome of surgical ICU patients on mechanical ventilation with and without ARDS is more favourable than that of medical ICU patients; --the interpretation of therapeutic results and of epidemiological data in ARDS patients is possible only by providing exact and detailed criteria; these should include compliance data; --evaluation of present ARDS therapy by comparison to previous data, even when the same criteria are applied, e.g. ECMO-criteria, may fail as the outcome of conventional therapeutic measurements - mechanical ventilation - may have improved. A controlled randomised trial might be more suitable for evaluation of alternative therapy in ARDS.
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Comparative Study
Sequential patterns of eicosanoid, platelet, and neutrophil interactions in the evolution of the fulminant post-traumatic adult respiratory distress syndrome.
Thirty multiply injured blunt-trauma patients at high risk for development of ARDS (multisystem trauma including more than one organ or extremity, Injury Severity Score of 26 or more, hypotension and need for 1500 mL or more blood within the first hour after admission, and PaO2 less than or equal to 70 torr) were studied sequentially with blood and physiologic evaluations beginning immediately after injury and every eight hours for eight days, or until death, to study the evolution of the ARDS process. Mixed venous blood samples were obtained for eicosanoids PGE2, PGF2 alpha, thromboxane B2, PGI2 (6-KetoPGF1 alpha) and leukotriene B4 (LTB4). Platelet (PLAT), and neutrophil (WBC) counts were also done and plasma elastase was measured. ⋯ The significant difference in the pattern and sequence of events in ARDS compared to TR and TS patients suggests that in ARDS the earliest event may be related to peripheral release of PGE2 and LTB4 due to platelet activation and lung sequestration with release of PGF2 alpha, and by aggregation and leukocyte adherence with release of elastase. However, fulminant ARDS mortality appears to be related to the subsequent amplification of the LTB4 leukocyte activation with superoxide production that does not achieve significance before the second day after injury and rises to a maximum by day 4 after injury. These data suggest that post-trauma ARDS follows a different evolutionary pattern than that reported in animal models and is also different from that seen in human TS or TR patients.(ABSTRACT TRUNCATED AT 400 WORDS)
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Although adult respiratory distress syndrome (ARDS) has been a recognized entity for over 20 years, estimates of its incidence have been very controversial. The most quoted figure is from a 1972 National Heart and Lung Institute Task Force, which estimated 150,000 cases/year in the United States, an incidence of about 75 cases/100,000 population. No experimental study, however, has adequately addressed this issue. ⋯ An average of ten patients per year, representing an incidence of 1.5 cases/100,000 population, were diagnosed as having ARDS and the mortality rate was 70%. Using a more liberal clinical criterion of PaO2 less than or equal to 75 mm Hg with FIO2 greater than or equal to 0.5, 44 more patients with ARDS, representing a total incidence of 3.5 cases/100,000 population, were identified. In conclusion, the overall incidence of ARDS was 1.5 to 3.5 cases/100,000 population, an incidence that is much lower than most previously published estimates.