Articles: respiratory-distress-syndrome.
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Critical care medicine · Jun 1989
Discrepancies between transcutaneous and end-tidal carbon dioxide monitoring in the critically ill neonate with respiratory distress syndrome.
PaCO2, transcutaneous PCO2 (PtcCO2), and end-tidal PCO2 (PetCO2) measurements were studied in 12 critically ill neonates. PtcCO2 was measured using a combination CO2/O2 sensor during the routine care of these patients. End-tidal sidestream sampling was performed during blood gas measurement as dictated by the patient's clinical condition. ⋯ The presence or absence of a metabolic acidosis did not have a significant effect on the slopes obtained. PtcCO2 monitoring using combined sensors is a useful and practical means of monitoring in the neonatal ICU, although acidosis affects the ability to correlate transcutaneous and arterial values. End-tidal sidestream measurements are not as clinically useful because they vary due to different ventilation/perfusion relationships in the sick neonate.
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The adult respiratory distress syndrome is a condition of life-threatening organ failure triggered by blood-borne factors and challenges which arrive via the airways. Vascular damage is a necessary, but often not sufficient criterion for ARDS, which is observed in an acute and chronic form. ⋯ Chronic ARDS is a proliferative disorder which may require different treatment strategies than acute ARDS. Specific treatment modalities which inhibit the interaction between activated neutrophils and the lung endothelium, and surfactant replacement might have a future as early therapy approaches.
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Since 1984, 11 newborns with severe respiratory distress have been treated whose clinical characteristics appear distinctive. Characteristics of these neonates were as follows: (1) they were full term by obstetric and neonatal criteria, (2) they had diffuse bilateral alveolar opacification on chest radiographs during the acute illness, (3) each had an acute perinatal triggering insult, (4) the neonates required continuous positive pressure ventilation for at least 48 hours with FiO2 greater than 0.50 for at least 12 hours, (5) they needed positive end-expiratory pressure of 6 cm of H2O or greater within three days of the triggering event, (6) there were no other known causes of these clinical conditions. Ten (91%) neonates had evidence of other organ dysfunction in addition to the lungs. ⋯ All 11 babies survived but required prolonged mechanical ventilation and supplemental oxygen. We suggest that adult respiratory distress syndrome can and does occur in newborns. A trial of positive end-expiratory pressure greater than or equal to 6 cm of H2O should be considered in full-term infants with severe respiratory distress in whom other causes can be excluded.
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Hemodynamic and pulmonary gas exchange consequences of 20 percent intravenous fat emulsion infusion (3.0 +/- .3 mg/kg/min) were evaluated in 19 patients who demonstrated ARDS. Lipid infusion precipitated a significant reduction in PaO2/FIO2 from 241 +/- 50 to 184 +/- 41 (mean +/- SD) and increased MPAP from 26.0 +/- 5.1 to 31.8 +/- 4.8 mm Hg, pulmonary vascular resistance from 149 +/- 78 to 179 +/- 61 dyne.s/cm5 and pulmonary venous admixture (Qva/Qt) from 20.7 +/- 15.2 to 30.6 +/- 8.6 percent. ⋯ We conclude that intravenous lipid administration was associated with increased MPAP and Qva/Qt in patients with ARDS, particularly when accompanied by septicemia. Although these alterations resolved after the lipid infusion was terminated, we suggest that prudent measures should be taken to guarantee adequate oxygenation during intravenous fat emulsion therapy in patients suffering from ARDS.
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Anasth Intensivther Notfallmed · Jun 1989
Case Reports[Adult respiratory distress syndrome in legionella pneumonia--successful treatment with extracorporeal CO2 elimination procedures].
We report on successful treatment of an 46-year-old patient with ARDS (Adult Respiratory Distress Syndrome), caused by legionella-pneumophilia-pneumonia. The treatment with conventional artifical mechanical ventilation had failed. ⋯ Supported by antimicrobial therapy with Erythromycin and Rifampicin the lung function could be improved to "restitutio ad integrum". Changes in chest radiographs, clinical parameters of ventilation, gas exchange and haemodynamics as well as the results of sequential pulmonary studies are demonstrated and discussed.