Articles: respiratory-distress-syndrome.
-
Acta Anaesthesiol Belg · Jan 1984
Volume limited ventilation for treatment of severe respiratory distress in neonates.
Ventilatory treatment of the very small infant with severe respiratory distress remains controversial. At several occasions pressure limited ventilators have shown not to provide adequate alveolar ventilation in these newborn babies. On the other hand, until now few data are found concerning the ventilation of newborns with volume limited ventilators. The authors report two cases with successful ventilation using a servo controlled volume limited machine and they stress the possibilities and advantages of such a type of ventilator in a neonatal intensive care unit.
-
Comparative Study
Complete extracorporeal removal of metabolic carbon dioxide by alkali administration and dialysis in apnea.
The high mortality rate of patients afflicted with adult respiratory distress syndrome (ARDS) may be due, in part, to the hemodynamic changes and the barotrauma accompanying mechanical ventilation, especially when high positive pressure and oxygen tension are used. Recent experimental evidence suggests that prognosis may be improved by suspending ventilation: in the apneic condition, oxygenation can be maintained by transalveolar oxygen diffusion, while extracorporeal carbon dioxide removal (ECCO2R), achieved with membrane lungs, assures CO2 homeostasis. This technology, however, requires high blood flow rates, and is available only to very few specially equipped centers. ⋯ Sodium and fluid balance were maintained by ultrafiltration. Observations in five dogs confirm that systemic pCO2, TCO2, and pH can be maintained well within physiologic ranges, and that prolonged apnea followed by full recovery can be achieved with this methodology. Because of the wide availability of dialysis equipment and expertise, and of lower extracorporeal blood flow requirements, ECCO2R by alkali administration and hemodialysis offers a potentially attractive alternative approach to the use of membrane lungs in the apneic therapy of ARDS.
-
The Journal of pediatrics · Nov 1983
Interaction of spontaneous respiration with artificial ventilation in preterm babies.
During a four-month period, all babies who received mechanical ventilation in the Neonatal Intensive Care Unit were studied to determine the effects of artificial ventilation on spontaneous respiratory activity. The babies were either totally apneic or ventilator inflation stimulated one of four distinct spontaneous respiratory patterns: synchronous breathing, Hering-Breuer reflex, augmented inspiration, or active expiration against ventilator inflation. ⋯ Only one pattern, active expiration against ventilator inflation, was consistently recorded before the development of pneumothorax. Preliminary evidence indicates that immediate paralysis of the baby as soon as that pattern is demonstrated may prevent the occurrence of pneumothoraces.
-
Comparative Study Clinical Trial Controlled Clinical Trial
Effect of end-expiratory pressure on total oxygen dynamics.
The role of altered end-expiratory pressure on total oxygen dynamics was studied prospectively in 18 patients with injuries and sepsis. Eight patients received high tidal volumes (12 to 18 ml/kg), continuous positive airway pressure, and intermittent mandatory ventilation (CPAP/IMV); 10 patients received low tidal volumes (8 to 10 ml/kg) with zero end-expiratory pressure and assist control mode of ventilation (ZEEP/A-CM). CPAP/IMV patients had better oxygen tension, reduced physiologic shunting in the lung (24% versus 18%), and an improved arterial tension: inspired oxygen concentration ratio. ⋯ Consequently, the total oxygen delivery was reduced for all 3 days following insult and for the cumulative data for all 3 days (266 versus 306 ml/min) in the CPAP/IMV patients. Oxygen consumption was also reduced in the CPAP/IMV patients; this reduction was not significant for each of the first 3 days but was significant when the data for the 3 days were added to the analysis (306 versus 272 ml/min). Future prospective randomized studies are needed to determine the most effective use of ventilatory support on total oxygen dynamics including oxygen delivery and oxygen consumption.