Articles: respiratory-distress-syndrome.
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Indian J Chest Dis Allied Sci · Jul 1996
ReviewAcute respiratory distress syndrome (ARDS) in miliary tuberculosis: a twelve year experience.
Miliary tuberculosis [MTB] is an uncommon but important treatable cause of acute respiratory distress syndrome [ARDS]. In this communication, six patients with MTB who developed ARDS in the course of their illness are described. The difficulties encountered in diagnosing MTB as a primary cause of ARDS are highlighted. The pathogenetic mechanisms of ARDS in MTB are briefly reviewed.
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The Journal of pediatrics · Jul 1996
Randomized Controlled Trial Clinical TrialRoutine use of fentanyl infusions for pain and stress reduction in infants with respiratory distress syndrome.
To determine whether fentanyl infusions given to premature infants with respiratory distress syndrome reduce stress and improve long- and short-term outcome. ⋯ Although there was a reduction in stress markers in the infants receiving fentanyl, we were unable to demonstrate an improvement in catabolic state or long-term outcome. In addition, the infants receiving fentanyl required higher ventilatory support in the early phase of respiratory distress syndrome than did those receiving placebo.
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Critical care clinics · Jul 1996
ReviewHigh-inflation pressure and positive end-expiratory pressure. Injurious to the lung? No.
Survival rates in ARDS with conventional ventilation using high oxygen fractions and low PEEP levels have been reported to be less than 10%. In three prospective evaluations of ARDS in the 1980s, mortality rates remained greater than 60%. Early studies using high-level PEEP therapy in severe ARDS by Douglas, Downs, Kirby, and Civetta showed improved survival rates with ranges between 60% and 80%. ⋯ Currently available information indicates that increases in mean airway pressure (induced with PEEP or other modes of ventilatory support to restore losses in FRC that occur during ARDS) and limiting exposure to toxic concentrations of oxygen minimize ventilator-induced secondary lung injury and maximize chances for survival. Arbitrary limitations of peak inspiratory or end-expiratory airway pressure or mandatory tidal volume in patients with severe ARDS seem to be unfounded. Failure to achieve adequate physiologic end-points in these patients may increase morbidity and mortality rates.
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The authors describe, to their knowledge, the first management of acute airway obstruction in a newborn infant using Extracorporeal Membrane Oxygenation (ECMO). The infant had a primary diagnosis of gram negative sepsis complicated by pulmonary hemorrhage resulting in a left main stem bronchus obstruction. Despite full ventilatory support, the infant could not be adequately oxygenated. ⋯ Airway management also included vigorous physiotherapy, suctioning, and bronchoscopy. The infant was successfully weaned from ECMO after 208 hours. The authors suggest that ECMO could be useful to manage life threatening airway obstruction in the neonate.