Articles: respiratory-distress-syndrome.
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Cahiers d'anesthésiologie · Jun 1985
[Lung infection and acute adult respiratory distress syndrome during surgical resuscitation].
Non cardiogenic pulmonary edema (PE) is frequently observed during the postoperative period. 56 patients with postoperative PE were divided into two groups: ARDS, acute respiratory distress syndrom and NHPE, non hemodynamic PE. The incidence of primary pulmonary infection and pulmonary superinfection were investigated. Both groups were not different except for the level of PaO2 lower in ARDS. ⋯ Blood cultures were more frequently positive during abdominal sepsis than during pneumonia. Viral etiology was thrice noted in 13 pneumonitis. Value of diagnostic methods for respiratory infections is discussed.
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Case Reports
Idiopathic pulmonary fibrosis in adult respiratory distress syndrome. Diagnosis and treatment.
Ten consecutive patients who presented initially with adult respiratory distress syndrome, and who did not respond to conventional treatment, underwent open lung biopsy early in the course of their illness. Idiopathic pulmonary fibrosis was diagnosed and aggressive treatment with methylprednisolone sodium succinate and nutritional support was initiated. Eight patients survived and have not required long-term corticosteroid therapy. Previous reports have documented a mortality of greater than 85% with this particular syndrome of idiopathic pulmonary fibrosis in adult respiratory distress syndrome.
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To assess the concurrent influence on extravascular lung water (EVLW) content of the intravascular Starling forces, the pulmonary capillary wedge pressure (PCWP), and the colloid osmotic pressure (COP), we measured EVLW by the thermal green dye technique in 174 patients with and without radiographically defined pulmonary edema; in the former group, patients with cardiac (CPE) and noncardiac (NCPE) causes of pulmonary edema were compared (study A). In 119 patients, EVLW was again measured one to three days later (study B). Patients with CPE demonstrated a significantly lower EVLW (9.3 +/- 3.9 ml/kg) (mean +/- SD) than patients with NCPE (14.5 +/- 4.9 ml/kg; p less than 0.05), despite a higher mean PCWP in the former group (20 +/- 7 mm Hg) than in the latter (12 +/- 6 mm Hg; p less than 0.05). ⋯ In study B the change (delta) in EVLW between the two studies was described as follows: delta EVLW = 0.25 + 0.173 delta PCWP (p less than 0.01) + 0.663 group NCPE (p, not significant) + 0.236 group NCPE X delta PCWP (p less than 0.01). This latter equation indicated that the EVLW content manifested a greater change with concurrent alterations in the PCWP in patients with NCPE than was found in patients with only a hydrostatic influence to EVLW formation. Therefore, NCPE is characterized by a greater measurable thermal green dye EVLW than is observed in CPE at any given PCWP, and the PCWP synergistically influences EVLW accumulation in both CPE and NCPE.
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Bull Eur Physiopathol Respir · May 1985
Comparative StudyConstant mean airway pressure with different patterns of positive pressure breathing during the adult respiratory distress syndrome.
Twenty-one ARDS patients were divided into two groups of severity according to FIO2 and PEEP required to maintain an adequate gas exchange. The 10 most severe patients (group A) underwent continuous positive pressure ventilation (CPPV) (I/E 3:1) with the mean airway pressure maintained at 21 +/- 6.2 cmH2O. The PEEP values were 12.6 +/- 4.3 cmH2O during CPPV and 6.5 +/- 3.7 cmH2O during IRV (p less than 0.01). ⋯ In five patients of each group, the SF6 shunt was measured as representative of true shunt. The results showed that gas exchange, including true shunt, and haemodynamics did not change between CPPV and IRV and between CPPV and CPAP tests. Taken with previous work on mean airway pressure, our results further support the concept that the main determinant of oxygenation and haemodynamics is the mean airway pressure, irrespective of the PEEP level and of the mode of ventilation.
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Acta Paediatr Scand · May 1985
Evaluation of a transcutaneous oxygen and carbon dioxide monitor in a neonatal intensive care department.
Transcutaneous-PO2 (tc-PO2 (tc-PCO2) at 44 degrees C and transcutaneous-PCO2) at 38, 42, 43 and 44 degrees C were measured with a currently available monitoring system (TCM222, Radiometer, Copenhagen) in 64 newborn infants with severe respiratory insufficiency during the first five days of life. Tc-PCO2 at all four temperatures correlated better with arterial blood-PCO2 (aB-PCO2), than tc-PO2 with aB-PO2. However, the sensitivity and specificity of tc-PO2 and tc-PCO2 were similar with regard to maintaining aB-PO2 and aB-PCO2 within specified limits. ⋯ The coefficient of variation of duplicate measurements was 10% for tc-PO2 and 5% for tc-PCO2. Electrode drift after an average of 3 hours patient monitoring was 2% +/- 6% (1 SD) for tc-PO2 and -3% +/- 6% for tc-PCO2. We conclude that tc-PO2 and tc-PCO2 are a valuable supplement to arterial blood gas measurements, but the variable correlation with arterial blood gas values and the electrode drifts which may occur, mean that they cannot fully replace arterial sampling.