Articles: respiratory-distress-syndrome.
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Case Reports Comparative Study
High frequency venturi jet ventilation. Adult respiratory distress syndrome--a case report.
A Penlon Nuffield Series 200 Ventilator, adapted for use as a high frequency jet ventilator, was used to treat a patient with adult respiratory distress syndrome. Adequate alveolar ventilation with this method was achieved with lower mean intrapulmonary pressure (5.4 cmH2O) than with conventional intermittent positive pressure ventilation (IPPV) (6 cmH2O). An improved cardiac output was also apparent, as judged by a better systemic blood pressure [105/50 mmHg for high frequency jet ventilation (HFJV) compared to 90/40 mmHg for IPPV] and a lower central venous pressure 6 cmH2O for HFJV as compared to 9.5 cmH2O with conventional IPPV. ⋯ This allowed an assessment to be made of any potential neurological damage caused by the cervical fracture. An assessment had not been possible during conventional ventilation due to the heavy narcotic and sedative regime required to settle the patient. This case report provides further evidence that HFJV is a useful adjunct in the management of patients requiring mechanical ventilation and also that the Penlon Nuffield Series 200 Ventilator is capable of high frequency jet ventilation.
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Twenty infants, mechanically ventilated in the neonatal period for respiratory distress syndrome, were compared with 15 healthy controls, matched for birthweight(less than 1501 g) but greater in mean gestational age. Clinical features and lung mechanics (by whole body plethysmography) were recorded at 6-monthly intervals until about one year. THe neonatal course of the mechanically ventilated infants was commonly complicated by tracheobronchial hypersecretion and the later course by a fairly high incidence of lower respiratory tract illness. ⋯ Early lung function tests were of limited value in predicting later lower respiratory tract illness, which was more common in boys, after neonatal mechanical ventilation for longer than 24 hours or raised ambient oxygen for longer than 5 days. There were few predictive physical signs. In this group of very low birthweight infants, respiratory distress syndrome of sufficient severity to require mechanical ventilation led to significant physiological and clinical disturbances of lung function which lasted into the second 6 months of life and which were particularly severe in those who had recurrent lower respiratory tract illness.
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Randomized Controlled Trial Clinical Trial
[A new indicator to determine the optimal PEEP (author's transl)].
To elucidate the optimal PEEP for respiratory treatment, respiratory and haemodynamic studies were performed on 12 normovolemic patients with ARDS for various levels of PEEP (PEEP = 0, 5, 10, 20 cm H2O). In this study, it became clear, that Suter's best PEEP (maximal O2 transport should be taken as a reference for optimal PEEP) cannot be used in practice because O2 transport is usually maximal in ZEEP (PEEP=0) and changes with the alteration of FIO2. We propose "intrapulmonary nonshunt flow ((Qt-Qs)" as a new indicator to determine the optimal PEEP. The level of PEEP to achieve the maximal intrapulmonary non-shunt flow must be such that the decrease in intrapulmonary shunt flow is attained with minimal decrease of cardiac output.
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The treatment of neonatal respiratory distress associates the improvement of lung ventilation with the correction of acid-base equilibrium (metabolic acidosis). In such a context we have considered 10 newborns with respiratory distress and we monitored pH, PCO2, B. ⋯ The sodium bicarbonate doses given as a result of the emogasanalisis are above those usually recommended. We then give suggestions on how to use the sodium bicarbonate required to correct the acidosis without the aid of an emogasanaliser in order to avoid the iatrogenic alcalosis danger.