Articles: respiratory-distress-syndrome.
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Scand. J. Clin. Lab. Invest. · Nov 1988
Intravenous 133Xe clearance in preterm neonates with respiratory distress. Internal validation of CBF infinity as a measure of global cerebral blood flow.
An intravenous 133Xe clearance technique is described, giving very low values of global cerebral blood flow (CBF infinity) in mechanically ventilated, preterm infants. External monitoring of the chest is used to estimate the arterial input function to the brain, with a modified correction to allow for increased recirculation due to right-to-left shunting. ⋯ Fifteen-minute clearance data gave better precision than 8-min data. The modified chest curve correction was partly effective in a case of extreme right-to-left shunting.
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Thirty-one patients with severe respiratory failure who were failing volume controlled conventional ratio ventilation were placed on pressure controlled inverse ratio ventilation (PC-IRV) for a total of 4,426 patient-hours. The PC-IRV resulted in a reduction of minute ventilation from 22 +/- 1.0 L/min (mean +/- SEM) to 15 +/- 0.7 L/min. Peak inspiratory pressure (PIP) was reduced from 66 +/- 2.3 cm H2O to 46 +/- 1.6 cm H2O and positive end expiratory pressures (PEEP) from 15 +/- 1.0 cm H2O to 2.5 +/- 0.5 cm H2O. ⋯ A lung compromise index (FIO2. PIP.10/PaO2) retrospectively distinguished between successful and unsuccessful PC-IRV episodes. These data suggest that PC-IRV can be successfully and safely implemented in critically ill patients with severe respiratory failure over prolonged periods of time resulting in significant improvement in oxygenation at lower minute volume, peak airway pressure and PEEP requirements.
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J. Thorac. Cardiovasc. Surg. · Oct 1988
Extracorporeal membrane oxygenation in children. New trends.
At the Children's Hospital of Pittsburgh the extracorporeal membrane oxygenation program was started in 1980. The results of our experience from 1980 to 1985 were previously reported. In the past 2 years 39 additional newborn infants have been treated with this modality, with an overall survival rate of 79% (31/39). ⋯ Four of our seven patients treated for this indication are long-term survivors. At present, because of the impossibility of using other forms of left ventricular assist devices in the pediatric population, it seems that extracorporeal membrane oxygenation is the most effective treatment for left ventricular failure after cardiopulmonary bypass. From our experience, even in the absence of long-term follow-up of patients supported with extracorporeal membrane oxygenation, it appears that the benefits of this therapeutic modality far exceed the risks in the high-risk population for which it is being used.