Articles: respiratory-distress-syndrome.
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Several reports state that oxygen uptake changed in direct correlation with changes in total oxygen delivery to the tissues in the adult respiratory distress syndrome (ARDS). Oxygen uptake appeared to be limited by oxygen delivery even at normally adequate levels so that uptake was abnormally dependent on supply. These reports are discussed with respect to whether or not such a result could have been due to errors in measurement or to mathematical coupling by relating two quantities that shared a common variable. ⋯ The accompanying loss of reactive hyperemia and inability to extract oxygen were consistent with a progressive loss of recruitable capillaries. Evidence is presented that the potential for embolization in ARDS is greatly enhanced by activation of the complement and arachidonic acid cascades as well as by the xanthine oxidase system. The resultant use of molecular oxygen by non-ATP producing oxidase systems might also account for the increase of supply dependent oxygen demand in ARDS.
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Lung injury in the adult respiratory distress syndrome (ARDS) may be mediated through a variety of mechanisms and may involve the interaction of a number of systems involved in the inflammatory reaction--complement, granulocytes, prostaglandins and platelets. Studies in animals, involving the infusion of endotoxin, have produced convincing evidence that these agents can cause pulmonary vascular injury and a syndrome resembling human ARDS. Direct evidence of these pathogenic mechanisms in man is lacking, however, but some suggestive clues have emerged in the last few years that support this general scheme. ⋯ Pulmonary sepsis continues to play an important role in ARDS. Patients are frequently infected after the initial pulmonary injury; such patients have a far worse prognosis than those who are not infected. Until ways are established at a cellular level to minimise colonisation of the upper respiratory tract, reliance must be placed on avoidance of cross infection by strict personal hygiene, avoidance of prophylactic antibiotics, and prompt, vigorous treatment of suspected pulmonary infection.
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Comparative Study
Adult respiratory distress syndrome: improved oxygenation during high-frequency jet ventilation/continuous positive airway pressure.
The role of high-frequency jet ventilation (HFJV)/continuous positive airway pressure (CPAP) and HFJV/intermittent mandatory ventilation (IMV) in the treatment of surgical patients with the adult respiratory distress syndrome were evaluated. To compare the efficacy of HFJV to IMV at a constant FiO2 and positive end-expiratory pressure, patients in surgical intensive care were randomized to receive IMV/CPAP therapy or one of three modes of HFJV: (1) HFJV/CPAP alone, (2) HFJV/CPAP + IMV (1), or (3) HFJV/CPAP + IMV (2). Each patient served as his own control. ⋯ Comparison of HFJV/CPAP + IMV (2) to HFJV/CPAP + IMV (1) demonstrated a significant improvement in oxygenation (p less than 0.025), but of lesser magnitude (8.4 +/- 11 torr). PaO2/FiO2 ratio and A-a gradient improved in both IMV (1) and IMV (2) subgroups. Oxygenation and ventilation/perfusion (V/Q) matching significantly improved with HFJV/CPAP + IMV (1), to a greater magnitude than with HFJV/CPAP + IMV (2) or HFJV/CPAP alone, and was the preferred method of ventilatory support.
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J. Thorac. Cardiovasc. Surg. · Oct 1984
T-lymphocyte analysis in the early diagnosis of adult respiratory distress syndrome.
Adult respiratory distress syndrome occurs concomitantly with a number of clinical conditions but has no known cause. At present, there is no generally acceptable method for establishing the early diagnosis. In the course of studying immune aberrations by means of monoclonal antibody staining and fluorescence-activated cell sorting in injured patients, we noted an apparent specific T-lymphocyte response to this syndrome in one patient. ⋯ When the patient recovered, the helper/suppressor ratio rose to above 3.0. T-lymphocyte analysis offers a promising means of evaluating patients considered highly susceptible to adult respiratory distress syndrome, i.e., victims of massive trauma. Further studies will be required to fully elucidate this possibility.
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Southern medical journal · Sep 1984
Adult respiratory distress syndrome: radiologic manifestations and course.
During a 36-month period, the serial chest x-ray films of 26 patients with the adult respiratory distress syndrome (ARDS) were evaluated for the patterns of onset, course, and follow-up appearance when possible. An exudative phase appearance can be recognized, which can clear. The exudative phase appearances are (1) a bilateral, homogeneous, white-out alveolar appearance; (2) an asymmetric consolidative appearance; and (3) a central perihilar ("bat-wing") consolidative appearance. This progresses to a proliferative phase manifested on chest x-ray film as an interstitial appearance that must not be confused with fibrosis, as the chest x-ray film may return to normal.