Articles: respiratory-distress-syndrome.
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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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To determine whether biologically active products of eosinophils, neutrophils and complement contribute to the development of adult respiratory distress system (ARDS) we measured eosinophil cationic protein (ECP), lactoferrin (LF) and C3a in bronchoalveolar lavage (BAL) and blood by means of radioimmunoassays. Seventeen patients served as controls. Fifteen patients were studied before and after major surgery to evaluate the influence of the surgical procedure, and 12 patients with ARDS were investigated 4-12 h after the onset of the disease. ⋯ One out of 12 ARDS patients died from the disease and this patient had the highest level of ECP in BAL and serum. Our results strongly support the role of activated polymorphonuclears, and notably the activated eosinophils, in the pathogenesis of ARDS. Evidence is also presented that ECP can be used as a predictor of impending ARDS.
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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.