Articles: respiratory-distress-syndrome.
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The anatomic and physiologic response to positive end-expiratory pressure (PEEP) was investigated using computed tomography (CT) in patients with adult respiratory distress syndrome (ARDS). The lesions (densities) in ARDS are distributed inhomogeneously but tend to concentrate in the dependent regions. The estimated lung weight (by CT scan, quantitative analysis, and lung gas volume measured with helium dilution) is, on the average, 200% higher than expected. ⋯ The main effect of PEEP is to clear the densities through alveolar anatomic recruitment. Anatomic recruitment changes the mechanical characteristics of the lung and parallels the improvement in gas exchange. The effects of PEEP on pulmonary arterial pressure appear to be related to anatomic recruitment.
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The gas exchange and hemodynamics were evaluated before, during, and after a two-hour period of prone position in 13 moderate-severe ARDS patients. Lung computerized tomography was obtained in both the supine and prone positions in two of these patients. Average arterial oxygenation improved after prone positioning (p less than 0.01). ⋯ One of these was a responder, the other a nonresponder. A brief test period in prone position is indicated in ARDS patients to identify those who may benefit from this postural treatment. The definite mechanism of the arterial oxygenation improvement observed remains to be clarified.
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Case Reports
Systemic lupus erythematosus, pulmonary hypertension and adult respiratory distress syndrome (ARDS).
The patient, a 30 year-old Caucasian female with a 6-year history of systemic lupus erythematosus was suspected of having pulmonary hypertension following chest X-Ray and routine echocardiography. Whilst awaiting further cardiological investigations she developed acute respiratory distress accompanied by gross signs of cor pulmonale and died despite full intropic and ventilatory support, in addition to intravenous "Pulse" methyl prednisolone. Postmortem findings showed typical features of the adult respiratory distress syndrome ('ARDS') but minimal vascular changes attributable to the pulmonary hypertension. The 'ARDS' was presumably associated with an acute 'flare' of the lupus.