Articles: respiratory-distress-syndrome.
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Case Reports
Severe lung damage after amniotic fluid embolism; a case with haemodynamic measurements.
A case is presented of non-fatal amniotic fluid embolism (AFE) with a severe shock complicated by acute respiratory distress syndrome (ARDS) with permanent pulmonary damage. Analysis of haemodynamic data of this patient suggests that diminished myocardial contractility and a decrease in peripheral vascular tone are the main causes of prolonged shock in AFE.
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Cardiorespiratory values were measured in nine patients with severe respiratory failure before and following initiation of pressure controlled inverse ratio ventilation (PC-IRV) at an inspiratory to expiratory ratio of 2:1. All patients showed increases in PaO2, with the mean PaO2 rising from 63 +/- 4 (mean +/- SEM) to 76 +/- 8 mm Hg. ⋯ In particular, no significant alteration in cardiac index, pulmonary artery pressures, oxygen delivery, oxygen consumption, or oxygen extraction ratio occurred with the use of PC-IRV. These results suggest that PC-IRV may be a useful ventilatory modality in the treatment of severe respiratory failure since it results in improvement in arterial oxygenation without any deterioration in hemodynamic or tissue oxygen metabolism parameters.
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The Adult Respiratory Distress Syndrome (ARDS) is a fulminant form of respiratory failure affecting many seriously ill patients. The early manifestations of ARDS are caused by increased permeability of the alveolo-capillary barrier leading to pulmonary edema, stiff lungs, and a large right-to-left intrapulmonary shunt. ⋯ ARDS therapy remains largely supportive and has had little impact on mortality. The complications of infection and multiorgan failure play important roles in determining ARDS outcome.
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Since its description 20 years ago, the mortality from ARDS has remained largely unchanged despite improved intensive care techniques. This article reviews the rationale underlying the current management of ARDS. In part 2 of this article some of the more recent and novel therapies that are being applied in the treatment of this condition will be described.