Articles: respiratory-distress-syndrome.
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Hemofiltration has been advocated for reduction of extravascular lung water (EVLW) in both clinical and experimental ARDS. The influence of hemofiltration on EVLW was studied retrospectively in 10 patients with this syndrome. After 2 to 38 hours' hemofiltration net fluid balance was -3640 +/- 3609 ml. ⋯ In 4 patients a reduction of over 15% in EVLW was achieved, whereas in the remaining 6 patients EVLW changed within a range of +/- 10%. However, hemofiltration caused a decrease in cardiac output and oxygen delivery, thereby adversely affecting its benefits on EVLW and gas exchange. In ARDS hemofiltration should be performed under careful hemodynamic monitoring and only in some of the patients an immediate reduction in EVLW can be achieved.
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Pediatr. Infect. Dis. J. · Mar 1987
Evaluation of routine lumbar punctures in newborn infants with respiratory distress syndrome.
Infants with respiratory distress syndrome are routinely evaluated for infection which commonly includes a lumbar puncture. In this study cerebrospinal fluid (CSF) examination failed to elicit evidence for meningitis in 238 consecutively admitted infants with respiratory distress syndrome evaluated during the first 24 hours of life. Blood cultures were obtained in all; suprapubic or catheterized urine was obtained in 163 infants; CSF was collected successfully in 203 infants. ⋯ CSF obtained from 14 of those infants had normal examinations and sterile cultures. Factors associated with bacteremia were birth weight (P less than 0.01), gestational age (P less than 0.01), prolonged rupture of membranes (P less than 0.05) and leukopenia below 10 000/mm3 (P less than 0.05). In view of the negative CSF examinations in infants with positive blood cultures and the potential complications of lumbar puncture (hypoxia, trauma, infection, epidermoid tumor), the potential risks of CSF evaluation may exceed the assessed benefit for the infant with respiratory distress syndrome.
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Critical care medicine · Mar 1987
Comparative StudyComplement activation and increased alveolar-capillary permeability after major surgery and in adult respiratory distress syndrome.
The concentrations of C3a des Arg were measured in bronchoalveolar fluid (BAL) and plasma from 12 patients with adult respiratory distress syndrome (ARDS). Compared with 32 controls, all patients had increased BAL fluid levels (p less than .001), and nine of 12 had increased plasma levels (p less than .001) of this split product from the third complement component. Reduced total hemolytic activity (CH50) in serum was seen in five patients (p less than .01). ⋯ Of the 12 ARDS patients, eight had increased BAL fluid concentrations of C3a (p less than .001), and ten had increased BAL fluid levels of albumin (p less than .001) compared with the post-surgical patients. Measuring complement consumption in blood by these techniques is of limited value in ARDS due to the lack of specificity. BAL fluid albumin has a similar degree of sensitivity and specificity for ARDS as does BAL fluid C3a.(ABSTRACT TRUNCATED AT 250 WORDS)
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The adult respiratory distress syndrome (ARDS) is a syndrome of diffuse lung injury with a high mortality rate. We evaluated retrospectively 35 adult patients with ARDS. Their overall mortality rate was 69% and was related to their age (32 +/- 14 yr in survivors and 54 +/- 15 yr in nonsurvivors; p less than .001) and to the number of complications during their illness (1.4 complications in survivors, 2.6 in nonsurvivors; p less than .005). ⋯ Neither a simplified acute physiology score nor a respiratory failure severity index was significantly different between survivors and nonsurvivors on admission. The mean PEEP level on admission in survivors was 8.1 +/- 4.6 cm H2O and in nonsurvivors 3.7 +/- 3.9 cm H2O (p less than .025). We conclude that the age of the patients and superimposed multiple system organ failure are probably related with the still high mortality rate of this syndrome.
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Post-traumatic pulmonary insufficiency or the adult respiratory distress syndrome is not infrequently associated with multiple organ-system injury. Mortality presently approaches 50%. Mechanical ventilation (CMV) with continuous positive airway pressure (CPAP) remains the mainstay of therapy. ⋯ All patients on HFJV demonstrated improved CO2 elimination with the same hemodynamic profiles. Those on HFPG demonstrated comparable gas exchange and hemodynamic profiles with lower CPAP/PIP. Where measured, PAW was significantly lower with HFPG when compared with CMV.