Articles: respiratory-distress-syndrome.
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The key clinical features of adult respiratory distress syndrome are increasing dyspnea, tachypnea, and work of breathing; diffuse pulmonary infiltrations on chest radiographs; severe hypoxemia; and absence of a classic diagnosis. Adequate tissue oxygenation is the cornerstone of therapy. Therapeutic modalities include mechanical ventilation, fluid restriction, diuretics, and cardiotonic and vasopressor agents.
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Comparative Study
Pulmonary morphology in a multihospital collaborative extracorporeal membrane oxygenation project. I. Light microscopy.
This report presents the light microscopic morphology found at autopsy in 59 patients who participated in an organized controlled trial of extracorporeal oxygenation as therapy for acute respiratory failure. Observations were recorded as objectively as possible and were analyzed by computer. ⋯ The rapid progression of the lesions to fibrosis is emphasized as is the predilection of both early and late lesions to involve alveolar ducts to a far greater degree than the distal alveolar spaces. A unifying mechanistic hypothesis consistent with these observations, as well as others, is that the lesions may result as much from oxygen damage as from the original acute illness.
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In a group of 14 patients (7 males and 7 females) ventilated artificially for acute respiratory distress syndrome, the authors defined a level of optimal expiratory positive pressure giving an FiO2 = 1, an arterial pO2 greater than or equal to 400 mmhg and/or an intrapulmonary shunt less than or equal to 15%. Improvement in arterial pO2 under such conditions would appear to be related to maximum alveolar recrutment. This optimal level of expiratory positive pressure would appear to be independent of values of total static pulmonary compliance. The long term use of this technique would seem to be encouraging.
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Southern medical journal · Mar 1979
Case ReportsVentilation-perfusion lung imaging in diaphragmatic paralysis.
We have described a patient with paralysis of the diaphragm, in whom dyspnea, hypoxemia, and hypercapnia increased when he changed from the upright to the supine position. Ventilation (V) and perfusion (P) images of the right lung appeared to be normal and remained nearly the same in the upright and supine positions. In contrast, V and P images of the left lung were smaller than those of the right lung in the upright position and decreased further in the supine position. In addition, the ventilation image of the left lung was much smaller than the perfusion image in both positions.