Articles: respiratory-distress-syndrome.
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The Journal of pediatrics · Aug 1995
ReviewNew concepts in the treatment of children with acute respiratory distress syndrome.
Recent advances in mechanical ventilation, accompanied with a better understanding of the pathophysiology of ARDS, have resulted in a brighter outlook for the child who acquires this still dreaded disease. A greater understanding of the pathophysiology of ARDS has led to a heightened awareness that the care of these patients should be more than just supportive. The potential for exacerbation of lung injury by mechanical ventilation is real. ⋯ Centers with experience using ECMO in the setting of pediatric ARDS have better results than those where ECMO is infrequently used for this purpose. It is imperative that future studies of both mechanical ventilation and ECMO describe ventilation strategy and prospectively identify protocols or algorithms for ventilator management. Coupled with severity scores, ventilator techniques and ECMO can then be systematically compared in children with ARDS.
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Intensive care medicine · Aug 1995
Case ReportsInhaled nitric oxide for hemodynamic support after postpneumonectomy ARDS.
Inhaled nitric oxide (NO) has been reported to promote selective pulmonary vasodilation and better arterial oxygenation in cases of adult respiratory distress syndrome (ARDS) with pulmonary hypertension (PHT). However, the clinical relevance of these changes and their effects on outcome remain to be proven, since long-term inhalation carries a potential risk of toxicity. ⋯ NO resulted in better oxygenation and markedly improved hemodynamic status. As the underlying disease progressively worsened the patient became fully dependent on NO for hemodynamic support, and he died after 24 days of effective supportive therapy with inhaled NO.
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Ventilatory measurements especially in preterm infants are hampered by the additional apparatus dead space (face mask, pneumotach, shutter, ...). The apparatus dead space can be higher than the physiological dead space and affects gas exchange and blood gases significantly. For lung function testing in premature or term infants a background flow (flow-through technique) is frequently used to eliminate the apparatus dead space. ⋯ The ratio maxVin/VE decreased significantly (p < 0.05) with increasing frequency: from 4.4 +/- 0.8 (f < 40/min); 4.1 +/- 0.7 (f = 40-59/min); 3.8 +/- 0.5 (f = 60-79/min) to 3.4 +/- 0.4 (f > 80/min). With increasing frequency the flow signal becomes sinusoidal and the ratio maxVin/VE tends to pi. Therefore, during tidal breathing the background flow should be at least three but not more than the six times VE to avoid an impairment of measurements.
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Intrapulmonary distribution of a peptide-phospholipid (KL4) surfactant administered through an adapter permitting maintenance of positive end-expiratory pressure was compared with distribution by instillation with disconnection from mechanical ventilation in 10 surfactant-deficient Macaca mullata preterm infants. Animals received KL4 surfactant (200 mg/kg) when the arterial to alveolar (oxygen ratio) (a/Ao2) was < or = 0.22 (approximately 50 min after birth) on mechanical ventilation. Six rhesus infants received bolus instillation of two half doses of KL4 surfactant through an endotracheal tube adapter over 10-15 s while maintaining positive end-expiratory pressure (0.4 kPa) accompanied by turning to the right and left lateral positions for 60 s. ⋯ Intrapulmonary distribution of KL4 surfactant was determined using dye-labeled microspheres or [3H]dipalmitoylphosphatidylcholine-labeled surfactant, measured by colorimetry or by scintillation counting. Lungs of each monkey were processed into 50 +/- 5 pieces to determine distribution of radiolabel or microspheres and for scanning electron microscopy. The drop in oxygen saturation was greater among monkey infants disconnected from the ventilator for surfactant instillation.(ABSTRACT TRUNCATED AT 250 WORDS)