Articles: respiratory-distress-syndrome.
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The adult respiratory distress syndrome (ARDS) represents a common denominator of acute lung injury leading to alveolar flooding, decreased lung compliance, and altered gas transport. In the absence of specific etiology and therapy, the management of ARDS remains largely supportive. Ubiquitous use of intermittent positive-pressure ventilation with positive end-expiratory pressure (PEEP) improves arterial oxygenation but with some risk of pulmonary barotrauma and decreased cardiac output. The recent understanding of lung inflation as a modulator of right heart afterload and the effect of the right ventricle on global cardiac performance continues to redefine optimal patterns of ventilatory and hemodynamic intervention in ARDS.
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Critical care medicine · Nov 1986
Effect of intrinsic positive end-expiratory pressure on respiratory compliance.
We evaluated the influence of intrinsic positive end-expiratory pressure (PEEPi) on the measurement of static respiratory compliance in 15 adult patients with acute respiratory failure under mechanical ventilation. Modifying the inspiratory/expiratory ratio from 1:2 to 2:1, and the respiratory frequency from 15 to 20 and 25 breath/min significantly changed compliance values. Because PEEPi can increase the work of breathing, we suggest adjusting ventilatory variables to minimize PEEPi.
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Intracranial hemorrhage is a complication of extracorporeal membrane oxygenation for the treatment of neonatal respiratory failure. A retrospective review of 35 neonates treated with extracorporeal membrane oxygenation was performed; ten had intracranial hemorrhage. Infants with intracranial hemorrhage had lower birth weights and were gestationally younger than infants with intracranial hemorrhage. ⋯ One child is normal, the other died at 18 months of age. Based on the results of this study, the risk of intracranial hemorrhage appears low in neonates of greater than 34 weeks' gestational age who undergo extracorporeal membrane oxygenation treatment for severe respiratory failure. The use of extracorporeal membrane oxygenation, as it is presently performed, is contraindicated in neonates of less than 35 weeks' gestational age because of the risk of intracranial hemorrhage.
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Obstetrics and gynecology · Sep 1986
Case ReportsSuccessful spontaneous vaginal delivery during mechanical ventilatory support for the adult respiratory distress syndrome.
The adult respiratory distress syndrome is a common cause of acute hypoxemic respiratory failure in the adult that is associated with a high mortality. There is a limited experience with managing this entity in the gravid patient. A case of successful management of mother and fetus through spontaneous delivery is presented, followed by a discussion of the principles of supportive therapy.