Articles: respiratory-distress-syndrome.
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A clinicopathological correlation of the lungs on 68 cases dying from burns was carried out. The patients were divided into two main groups. Those in which the burns were the main cause of death (30 cases) and the others that had other serious underlying pathology as well as burns (38 cases). ⋯ Interstitial fibrosis was present in only 8/30 cases where burns were the main cause of death, and in some of these there were other causes for the fibrosis. No correlation was found between the presence of hyaline membranes, interstitial fibrosis and the percentage or duration of oxygen therapy. These findings once again question the validity of the concept of oxygen toxicity in man.
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We infused hyperoncotic albumin (25 or 50 gm of a 50% solution) into patients with noncardiac pulmonary edema (adult respiratory distress syndrome [ARDS]) to evaluate its effect on the transmicrovascular flux from blood to pulmonary edema fluid of two radiotracers--111In-DTPA (mol wt 504) and 125I-human serum albumin (HSA) (mol wt 69,000). Two groups of patients were studied--one with a modest increase in permeability of the pulmonary alveolocapillary membrane to 125I-HSA (group 1) and another with a large increase in permeability to 125I-HSA (group 2). We used furosemide, when necessary, to minimize the effect of albumin infusion to increase the pulmonary microvascular hydrostatic pressure (Pmv), measured clinically as the pulmonary capillary wedge pressure (PCWP). ⋯ In individual patients, a change in the Pmv in response to albumin infusion was directly correlated with the change in flux of 111In-DTPA [group 1: delta In-DTPA (%) = 8.66 + 1.4 delta Pmv (%) r = 0.51, P less than 0.02; group 2: delta In-DTPA (%) = -3.43 + 1.6 delta Pmv (%) r = 0.67, P less than 0.01]. A change in the transmicrovascular flux of I-HSA also correlated with a change in the intravascular Starling forces in both groups. We conclude that albumin infusion in patients with ARDS will not augment the pulmonary transmicrovascular flux of low or high molecular-weight solutes when the effect of albumin to increase the Pmv is minimized; nor, however, does an increase in plasma COP significantly reduce the flux of such solutes.
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Nihon Geka Gakkai zasshi · Apr 1983
[Studies on pre- and postoperative extravascular lung water changes in patients with esophageal cancer].
Pre- and postoperative extravascular lung water (EVLW) changes in a series of twenty patients with esophageal cancer were studied using thermal-dye double-indicator dilution method. Preoperative EVLW was 8.2 +/- 2.3 ml/kg (M +/- SD), being greater as compared to the normal range of EVLW. The pattern of postoperative EVLW changes varied between patients and changes could not be predicted by the conventional examinations including chest X-ray, determination of pulmonary hemodynamics and blood gas analysis. ⋯ Especially, the patients in which EVLW had increased during the 3rd to the 4th day showed a remarkable rise of PWP possibly due to depressed left ventricular function. It is considered that the EVLW increase on the first postoperative day is attributable to an alteration of the permeability characteristics of alveolar capillary but that the increase in the 3rd to 4th day is simply due to an elevated hydrostatic pressure. This suggests that there are two different kinds of mechanism involving in the production of wet lung following esophageal cancer surgery.
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J. Thorac. Cardiovasc. Surg. · Apr 1983
Case ReportsAdult respiratory distress syndrome following intrapleural instillation of talc.
After intrapleural instillation of talc for sclerosis of malignant pleural effusions, dyspnea occurred in three patients, progressed gradually over 72 hours, and culminated in acute respiratory failure characterized by bilateral diffuse pulmonary infiltrates with normal pulmonary artery occlusion pressures. Two patients recovered and one died. ⋯ This experience emphasizes that other agents are preferable for initial attempts to promote pleural symphysis in the palliation of recurrent malignant effusions. When talc is used in patients who are unresponsive to tetracycline, we suggest clinical monitoring for respiratory compromise for 72 hours after the procedure.