Articles: respiratory-distress-syndrome.
-
Intensive care medicine · Jan 1984
The role of total static lung compliance in the management of severe ARDS unresponsive to conventional treatment.
A group of 36 patients with severe adult respiratory distress syndrome (ARDS) meeting previously established blood gas criteria (mortality rate 90%) became candidates for possible extracorporeal respiratory support [low frequency positive pressure ventilation with extracorporeal CO2 removal (LFPPV-ECCO2R)]. Before connecting the patients to bypass we first switched the patients from conventional mechanical ventilation with positive end expiratory pressure (PEEP) to pressure controlled inverted ratio ventilation (PC-IRV), and then when feasible, to spontaneous breathing with continuous positive airways pressure (CPAP). Forty eight hours after the patients had entered the treatment protocol, only 19 out of the 36 patients in fact required LFPPV-ECCO2R, while 5 were still on PC-IRV, and 12 were on CPAP. ⋯ No patients with a TSLC lower than 25 ml (cm H2O)-1 tolerated either PC-IRV or CPAP, while all patients with a TSLC higher than 30 ml (cm H2O)-1 were successfully treated with CPAP. Borderline patients (TSLC between 25 and 30 ml (cm H2O)-1) had to be treated with PC-IRV for more than 48 h, or were then placed on LFPPV-ECCO2R if Paco2 rose prohibitively. We conclude that TSLC is a most useful measurement in deciding on the best management of patients with severe ARDS, unresponsive to conventional treatment.
-
The clinical course and outcome of 49 consecutive near-drowned patients is presented. All the immersions occurred in fresh water. 37 patients (76%) survived. All 28 patients who were conscious upon admission to hospital recovered fully. ⋯ Among unconscious patients, the non-survivors had on arrival an average lower rectal temperature than the survivors. The following factors during intensive care correlated with bad prognosis: low PaO2/FiO2, low serum protein concentration and disturbances in renal function. Furthermore, the findings of this study suggest that although a specific near-drowned patient has on admission most abnormal laboratory values, these do not predict his fate, but effective treatment has to be given.
-
Critical care medicine · Jan 1984
Case ReportsSevere hypoxemia without evidence of tissue hypoxia in adult respiratory distress syndrome.
A patient with severe arterial hypoxemia in adult respiratory distress syndrome (ARDS) secondary to a fractured femur is reported. A marked discrepancy between the clinical condition and laboratory findings was observed. At one point, PaO2 was below 4 kPa (30 mm Hg) on F1O2 0.21 without signs of tissue hypoxia. This patient illustrates beneficial effects of a leftward shift of the oxyhemoglobin dissociation curve.
-
Comparative Study
[Effect of positive end expiratory pressure on the intrapulmonary shunt and the oxygen alveolo-arterial difference in adult acute respiratory distress].
The aim of this study was to analyse two groups of 10 patients with hypoxaemia. One group of patients had acute respiratory distress (A. R. ⋯ R. D. A. group of patients, the shunt does not vary with the PEEP and the difference remains negative.
-
The adult respiratory distress syndrome (ARDS) is a common syndrome of diffuse lung injury with high mortality. An underlying mechanism is pulmonary microvascular injury leading to increased permeability, pulmonary edema and impaired gas exchange. ⋯ The development of an accurate clinical marker of pulmonary microvascular injury or a technique to measure pulmonary microvascular permeability may allow earlier and more specific diagnosis. We review ARDS with emphasis on recent work concerning the mechanisms of lung injury, diagnosis, and therapy.