Articles: respiratory-distress-syndrome.
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J. Korean Med. Sci. · May 2022
Outcomes of Late-Preterm and Term Infants Born to SARS-CoV-2-Positive Mothers.
With the spread of coronavirus disease 2019 (COVID-19) in Korea, the number of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rapidly increasing. A shortage of negative-pressure isolation rooms for newborns makes hospital assignment more difficult for late-pregnant women with COVID-19. Among 34 infants born to SARS-CoV-2-positive mothers, 5 (14.7%) presented with respiratory distress and 1 (2.9%) presented with feeding intolerance that required specialized care. ⋯ Overall outcomes of 34 infants were favorable, and no infant tested positive for SARS-CoV-2. Most infants born to SARS-CoV-2-positive mothers did not need to be quarantined in a negative-pressure isolation room, and 17 (50%) mother-infant dyads were eligible for rooming-in. If negative-pressure isolation rooms are selectively used for newborns requiring aerosol-generating procedures or newborns in respiratory distress, resource availability for lower-risk cases may improve.
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Prone positioning improves survival in moderate-to-severe acute respiratory distress syndrome (ARDS) unrelated to the novel coronavirus disease (COVID-19). This benefit is probably mediated by a decrease in alveolar collapse and hyperinflation and a more homogeneous distribution of lung aeration, with fewer harms from mechanical ventilation. In this preliminary physiological study we aimed to verify whether prone positioning causes analogue changes in lung aeration in COVID-19. A positive result would support prone positioning even in this other population. ⋯ In fifteen patients with COVID-19, prone positioning decreased alveolar collapse, hyperinflation, and homogenized lung aeration. A similar response has been observed in other ARDS, where prone positioning improves outcome. Therefore, our data provide a pathophysiological rationale to support prone positioning even in COVID-19.
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Intensive care medicine · May 2022
Meta AnalysisThe role of acute hypercapnia on mortality and short-term physiology in patients mechanically ventilated for ARDS: a systematic review and meta-analysis.
Hypercapnia is frequent during mechanical ventilation for acute respiratory distress syndrome (ARDS), but its effects on morbidity and mortality are still controversial. We conducted a systematic review and meta-analysis to explore clinical consequences of acute hypercapnia in adult patients ventilated for ARDS. ⋯ Clinical effects of hypercapnia are conflicting depending on its mechanism. Permissive hypercapnia was associated with improved mortality contrary to imposed hypercapnia under PV, suggesting a major role of PV strategy on the outcome.
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Randomized Controlled Trial
Early Restrictive Fluid Strategy Impairs the Diaphragm Force in Lambs with Acute Respiratory Distress Syndrome.
The effect of fluid management strategies in critical illness-associated diaphragm weakness are unknown. This study hypothesized that a liberal fluid strategy induces diaphragm muscle fiber edema, leading to reduction in diaphragmatic force generation in the early phase of experimental pediatric acute respiratory distress syndrome in lambs. ⋯ Early fluid restriction decreases the force-generating capacity of the diaphragm and diaphragmatic microcirculation in the acute phase of pediatric acute respiratory distress syndrome. In addition, the application of positive end-expiratory pressure decreases the force-generating capacity of the diaphragm in a dose-related way. These observations provide new insights into the mechanisms of critical illness-associated diaphragm weakness.