Articles: respiratory-distress-syndrome.
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Recent publications have suggested that in infants receiving artificial ventilatory support a particular pattern of interaction between spontaneous breaths and ventilator inflations (active expiration against each ventilator inflation) may be important in the production of pneumothoraces. We have looked at patterns of interaction from 47 preterm infants studied on 51 occasions. ⋯ This pattern was prevented on 14 occasions by altering the ventilator settings. In two other babies, the pattern persisted but neither baby developed a pneumothorax.
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The management of impaired respiratory gas exchange in patients with nonuniform posttraumatic and septic adult respiratory distress syndrome (ARDS) contains its own therapeutic paradox, since the need for volume-controlled ventilation and PEEP in the lung with the most reduced compliance increases pulmonary barotrauma to the better lung. A computer-based system has been developed by which respiratory pressure-flow-volume relations and gas exchange characteristics can be obtained and respiratory dynamic and static compliance curves computed and displayed for each lung, as a means of evaluating the effectiveness of ventilation therapy in ARDS. Using these techniques, eight patients with asymmetrical posttraumatic or septic ARDS, or both, have been managed using simultaneous independent lung ventilation (SILV). ⋯ Also, there was x-ray evidence of ARDS improvement in the poorer lung. While the ultimate outcome was largely dependent on the patient's injury and the adequacy of the septic host defense, by utilizing the SILV technique to match the quantitative aspects of respiratory dysfunction in each lung at specific times in the clinical course, it was possible to optimize gas exchange, to reduce barotrauma, and often to reverse apparently fixed ARDS changes. In some instances, this type of physiologically directed ventilatory therapy appeared to contribute to a successful recovery.
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Critical care medicine · Oct 1985
Pulmonary interstitial emphysema in the adult respiratory distress syndrome.
Chest x-rays of 15 patients with the adult respiratory distress syndrome (ARDS) were evaluated retrospectively for the presence of pulmonary interstitial emphysema (PIE). PIE was radiographically detected in 13 (88%) patients, 10 (77%) of whom also had pneumothorax. In five of these, pneumothorax occurred within the first 12 h after interstitial emphysema appeared. ⋯ The appearance of PIE and its complications, i.e., pneumothorax and pneumomediastinum, occurred over a wide range of mean airway pressures and positive end-expiratory pressures; there was no direct relationship between barotrauma and mean airway pressure or positive end-expiratory pressure. In 12 of the 13 patients all manifestations of barotrauma occurred at or above a peak airway pressure of 40 cm H2O, indicating a threshold level of peak airway pressure which would place the ARDS patient at high risk for developing pulmonary barotrauma. Time on the respirator at peak airway pressures above 40 cm H2O, clinical severity of ARDS, and associated pulmonary pathology (emphysema, bacterial pneumonia) appear to play a role in developing barotrauma.