Articles: respiratory-distress-syndrome.
-
Extracorporeal Membrane Oxygenation (ECMO) has been available to neonates with respiratory failure at the University of Michigan School of Medicine since June 1981. In order to evaluate the impact of this type of pulmonary support, a retrospective analysis of 50 neonates with posterolateral congenital diaphragmatic hernia (CDH) who were symptomatic during the first hour of life and were treated between June 1974 and December 1987 was carried out. The patients were divided into two groups, those treated before June 1981 (16 patients) and those treated after June 1981 (34 patients). ⋯ These survival differences are significant (p less than 0.01). In addition, the survival of 87% for the infants treated with ECMO versus the expected mortality of greater than 80% for these same patients when treated with conventional therapy is highly significant (p less than 0.005). Based on this data, ECMO appears to be a successful, reliable, and safe method of respiratory support for selected, critically ill infants with CDH.
-
When positive end-expiratory pressure (PEEP) is applied to normal lungs, the pulmonary artery occlusion pressure (PAOP) may reflect alveolar pressure and not left ventricular end-diastolic pressure (LVEDP). The reliability of PAOP measurements has been questioned when PEEP levels greater than 10 cm H2O are applied. To verify whether this disparity occurs in patients with severe lung injury, the authors simultaneously measured both PAOP and LVEDP at 0, 10, and 16-20 cm H2O PEEP in 12 supine patients with severe adult respiratory distress syndrome (ARDS). ⋯ In only six of 35 simultaneous measurements was the PAOP-LVEDP gradient 2 mmHg or more (2-3 mmHg in four, and 4 mmHg in two). In five patients, the highest PEEP level was 4-9 cm H2O greater than LVEDP; however, no gradient was measured between LVEDP and PAOP. The authors conclude that, in severe ARDS, a close correspondence between PAOP and LVEDP is maintained despite applying PEEP levels up to 20 cm H2O, suggesting that, in ARDS, surrounding pathology prevents transmitted alveolar pressure from collapsing adjacent pulmonary vessels.