Articles: respiratory-distress-syndrome.
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Critical care medicine · Feb 1980
Case ReportsUse of volume loading to obtain preferred levels of PEEP. A preliminary study.
Hemodynamic and oxygen transport measurements were made with successive increments of positive end-expiratory pressure (PEEP) in 14 episodes of ARDS in 11 patients who had normal or slightly increased blood volumes. "Preferred" or optimal PEEP was defined as the PEEP value associated with the greatest VO2 that did not compromise pulmonary function as determined by shunting (Qs/Qt). The preferred PEEP averaged 10.7 +/- 2.7 (SD) cm H2O in the patients who had appreciable reduction in cardiac index (CI) by the time this level of PEEP was reached. ⋯ The final preferred PEEP in these patients averaged 14.1 +/- 3.6 (SD) cm H2O. The authors conclude that the titration of PEEP as well as fluid therapy may be used to maximize VO2 in patients with early shock lung.
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Adult respiratory distress syndrome is a type of acute respiratory insufficiency which is preceded by a variety of serious illnesses. The radiologic appearance ranges from scattered densities early in the course to complete consolidation later. ⋯ Treatment generally includes intubation, suctioning, oxygen and mechanical ventilation with positive end-expiratory pressure. Diuretics and methylprednisolone may also be used.
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In 14 patients with the respiratory distress syndrome it was demonstrated that this condition was caused by the administration of excessive volumes of fluid. In none of six patients examined post-mortem were any signs of thrombi or emboli observed in pulmonary vessels. Caution with the initial supply of fluids following major trauma and major surgery is recommended. By monitoring pulmonary arterial pressure, optimum volume replacement with 5% albumin solution for example can be achieved.