Articles: respiratory-distress-syndrome.
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We measured the tidal volume achieved during intermittent positive pressure ventilation using various inspiratory times with a minimum of 0.2 seconds. Results indicate that tidal volume shows no reduction with inspiratory times down to 0.4 seconds. An inspiratory time of 0.3 seconds, however, is likely to reduce tidal volume by 8%, and at 0.2 seconds a 22% fall may be anticipated.
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Critical care medicine · Mar 1985
Case ReportsSevere combined respiratory and myocardial failure treated with high-frequency ventilation.
High levels of positive end-expiratory pressure (PEEP) impair cardiac output. The subsequent lowering of mixed venous oxygenation, when coupled with a significant intrapulmonary shunt, may dramatically depress PaO2. We present a patient whose severe myocardial and respiratory insufficiency was unmanageable on conventional ventilation with high levels of PEEP and maximal inotropic support. High-frequency ventilation superimposed on conventional ventilation lowered peak airway pressure and dramatically improved both cardiac and pulmonary function.
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Critical care medicine · Mar 1985
Pathophysiology of adult respiratory distress syndrome after sepsis and surgical operations.
To describe the natural history of adult respiratory distress syndrome (ARDS) from the circulatory viewpoint, we measured hemodynamic and oxygen transport variables in a series of 126 postoperative and 65 septic ARDS patients. All patients had hypoxemia unresponsive to conservative measures and required mechanical ventilation. ⋯ Before the development of ARDS, both postoperative and septic patients exhibited hypovolemia, pulmonary vasoconstriction, suboptimal myocardial performance, and reduced oxygen delivery and consumption relative to the increased needs of the hypercatabolic state. Because these antecedent changes were greater in ARDS patients who died, their early correction (in addition to standard ventilatory support) may prevent the development of ARDS and decrease its mortality.
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Comparative Study
Adult respiratory distress syndrome in cases of severe trauma--the prophylactic value of methylprednisolone sodium succinate.
The more important known pathogenetic mechanisms apparently responsible for the development of adult respiratory distress syndrome (ARDS) are briefly discussed. Reactions in the development of ARDS for which corticosteroids are possibly beneficial are pointed out. ⋯ MPSS was administered to 47 seriously injured patients and omitted from the management regimen of 45 patients comparable as regards age and severity of injury. The percentage of patients who developed ARDS was significantly lower in the group that received MPSS than in the control group.
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Case Reports Clinical Trial
Granulocyte aggregation in adult respiratory distress syndrome (ARDS)--serial histologic and physiologic observations.
Although a number of studies have suggested that granulocyte sequestration is an important pathophysiologic event in ARDS, histologic evidence of aggregated granulocytes in the pulmonary microvasculature is limited, and serial histologic data have not been reported with physiologic measurements. We report a patient with ARDS who demonstrated microvascular granulocyte aggregation and lung edema in sections of a lung biopsy obtained seven days after the onset of symptoms. ⋯ A second biopsy performed 12 days later showed decreased lung edema and no evidence of intravascular leukostasis. This case provides histologic support for the hypothesis that granulocyte aggregates contribute to pulmonary edema associated with ARDS.