Articles: respiratory-distress-syndrome.
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Critical care medicine · May 1986
Respiratory failure in patients with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia.
Seven patients with acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia were studied to define the pathophysiology of their respiratory failure. The patients had fever, cough, dyspnea, hypoxemia, and diffuse infiltrates on chest x-ray. Biopsies revealed a spectrum of alveolar filling, interstitial edema and infiltration, and fibrosis. ⋯ There was no correlation between the effect of PEEP on compliance and its effect on shunt. The data suggest that in patients with AIDS and P. carinii pneumonia, PEEP can decrease shunt by reducing the anatomic shunt, improving V/Q imbalance, and converting areas of anatomic shunt to areas of low V/Q. P. carinii pneumonia in patients with AIDS can produce a clinical and pathophysiologic pattern similar to that described in the adult respiratory distress syndrome.
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ARDS yearly afflicts more than 150,000 people, many of whom are young and otherwise healthy and yet the mortality rate remains in excess of 60% to 70%. This high mortality has not yielded to the significant gains made in intensive care patient management and rapid advances in technology. Acute lung injury research in the past 15 to 20 years has greatly enhanced our understanding of the pathophysiologic mechanisms underlying this complicated disorder. ⋯ Fortunately, basic research has recently yielded promising results with pharmacologic interventions designed to limit lung injury or prompt lung repair. Clinical trials underway and proposed will determine which, if any, of these approaches is effective. Until success is achieved, supportive intensive care with diligent attention to infection control, fluid therapy, nutrition, and ventilator management will remain the focal point of therapy for ARDS.
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We have evaluated the use of laboratory parameters to predict the risk of adult respiratory distress syndrome (ARDS) at an early stage after major trauma. Patients with lung contusion were excluded. Five of 29 patients fulfilled our criteria of ARDS, i.e. ⋯ The most sensitive indicator of ARDS seemed to be the platelet count, although it was also related to blood loss and amount of blood transfused. Hence the platelet count should be considered in relation to blood replacement in the patient with major trauma. Tentative laboratory values are suggested to indicate risk levels of developing ARDS.
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A lethal case of Adult Respiratory Distress Syndrome (ARDS) consequent to meningococcal septicemia is clinically and physiologically described. Very high levels of eosinophil cationic protein and lactoferrin in bronchoalveolar lavage were observed in spite of peripheral eosinopenia and neutropenia. These findings provide support for the hypothesis that activated granulocytes are involved in the pathogenesis of septic-induced ARDS.
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Case Reports
Persistent hypoxemia due to patent foramen ovale in a patient with adult respiratory distress syndrome.
This report describes a patient in the recovery phase of the adult respiratory distress syndrome in whom the persistence of severe hypoxemia was not corrected by a high fractional concentration of oxygen in the inspired gas and positive end-expiratory pressure. A right-to-left interatrial shunt was diagnosed by M-mode and cross-sectional echocardiography with saline injection, and the presence of a patent foramen ovale was confirmed at the time of cardiac surgery.