Articles: respiratory-distress-syndrome.
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The rationale for surfactant therapy in premature infants is presented, along with a discussion of the characteristics of surfactant and a review of clinical trials of surfactant for the prevention and treatment of neonatal respiratory distress syndrome (RDS). RDS is a major complication of prematurity, affecting up to 40,000 infants in the United States and Canada annually. Poor lung compliance due to a functional or quantitative deficiency of surfactant causes progressive collapse of the lungs. ⋯ Surfactant has no appreciable toxicity, although the potential for immunogenicity exists. Typical doses range from 60 mg to 200 mg/kg administered endotracheally either before the first breath or after development of RDS. Surfactant is a safe investigational agent that appears promising for the prevention and treatment of neonatal RDS, although additional clinical trials with long-term follow-up are needed to determine its true efficacy.
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Am. J. Clin. Pathol. · Jul 1989
ReviewRegional alveolar damage (RAD). A localized counterpart of diffuse alveolar damage.
Diffuse alveolar damage (DAD) is usually considered a generalized lung process. During five years the authors observed 83 patients with generalized DAD in 827 adult autopsies (10.1%) and 10 patients with identical, but localized, lesions. The authors propose the term regional alveolar damage (RAD) to designate localized "DAD." RAD was unilateral in six patients and most frequently involved the upper lobe. ⋯ All patients developed respiratory failure, requiring supplemental oxygen and, in nine patients, mechanical ventilation. Chest roentgenograms revealed alveolar or combined alveolar and interstitial infiltrates that corresponded to the lesions found at autopsy. The reasons for localization of RAD within the lung are unclear, but the presence of proliferative lesions and frequent involvement of the upper lobe suggests that RAD is not simply an early phase of DAD and implicates additional pathogenetic factors.
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Critical care clinics · Jul 1989
ReviewMultiple systems organ failure (MSOF): lessons learned from the adult respiratory distress syndrome (ARDS).
The relationship between ARDS and MSOF is explored. Models include that ARDS represents only one organ failing in MSOF, or that MSOF is a complication of ARDS owing to the development of infection and sepsis syndrome in these patients. Data are reviewed suggesting an important role of infection and sepsis syndrome in both models.
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Am. Rev. Respir. Dis. · Jul 1989
Comparative StudyIn vitro versus in vivo comparison of endotracheal tube airflow resistance.
The mechanics of gas flow in endotracheal (ET) tubes have been evaluated extensively in vitro under static and dynamic conditions. Previous bedside determinations of respiratory system mechanics in patients with acute respiratory failure have been based on assumptions derived from in vitro measurements without direct measurement of in vivo ET tube resistance (RET). We hypothesized that the RET measured in vivo would be greater than those values obtained in vitro when peak flow rates and ET tube size were held constant. ⋯ Although there was considerable individual variation, values of RET measured in vivo were generally higher than those derived from in vitro measurements at both peak flow rates tested, perhaps because of secretions, head or neck position, tube deformation, or increased turbulence. We conclude that ET tubes contribute significantly to total airflow resistance and that RET is often significantly greater than indicated by in vitro studies. Estimates of work of breathing in critically ill patients must take into consideration the contribution of in vivo RET on total pulmonary system resistance.