Articles: respiratory-distress-syndrome.
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The justification for restricting fluid administration, or more directly, for actively trying to lower pulmonary capillary pressures during pulmonary edema, is embodied in the familiar "Starling equation." This model predicts that pulmonary edema will develop if lymph flow or changes in other so-called "safety factors" cannot compensate for increases in pulmonary capillary pressures. Numerous experimental studies support the logical extension of this paradigm, namely that reduced capillary pressures and/or reduced perfusion to acutely injured lung units will result in reduced extravascular lung water accumulation. ⋯ Furthermore, although a strategy of fluid restriction/diuresis could potentially increase the risk of either cardiac or renal dysfunction, currently available data suggest that this management strategy in euvolemic (and certainly in hypervolemic) ARDS patients can be pursued without clinically important deterioration in either type of organ function. Thus, on balance, a strategy of fluid restriction/diuresis should be pursued during the first few days of ARDS, while carefully monitoring and supporting the perfusion of vital organs.
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Conventional therapy in the management of adult respiratory distress syndrome is often associated with an increased mortality rate. Several methods to improve survival in patients with severe respiratory insufficiency are under evaluation. One recently developed method of treatment is an implantable intravascular oxygenator, which provides supplemental gas exchange for failing lungs. ⋯ Reduction in ventilator settings such as airway pressure, oxygen concentration, positive end-expiratory pressure and minute volume can be achieved, decreasing the likelihood of oxygen toxicity and barotrauma. Success of the intravascular oxygenator in adult respiratory distress syndrome is dependent in part on critical care staff expertise. Therefore, a thorough understanding of the operation of this device and its role in acute respiratory failure is necessary for optimal care.
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Comparative Study
"Minitouch" treatment of very low-birth-weight infants.
In a cohort study with historical controls of non-asphyxiated very low-birth-weight infants (birth weight < or = 1500 g and gestational age < 33 completed weeks), we evaluated the use of a "minitouch" regime for stabilization after birth and treatment of respiratory distress. This combination of early (prophylactic) treatment with nasal continuous positive airway pressure and minimal handling was introduced as a routine in our Department in 1986. We compared infants born in 1987 and in 1985, when ventilator treatment was used initially in all infants with progressing respiratory distress. ⋯ Septicaemia was diagnosed in 16% of the infants in 1987 versus 7% in 1985 (p = 0.045). This difference coincided with an increased use of total parenteral nutrition (18% in 1987 versus 3% in 1985, p = 0.007). We conclude that the minitouch regime prevents progression of respiratory distress, reduces the need for ventilator treatment and is a safe and convenient alternative to mechanical ventilation in preterm infants with mild respiratory problems.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
Increased blood pressure during inverse ratio ventilation in two patients with adult respiratory distress syndrome.
Inverse ratio ventilation (IRV) is increasingly used in the supportive treatment of patients with hypoxemic respiratory failure. A recent study suggests that IRV reduces cardiac output with minimal effect on mean arterial pressure. We report two cases in which IRV led to reproducible increases in mean arterial pressure. Concomitant hemodynamic measurements suggest that these responses occurred as a result of increased vascular resistance.
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The Journal of pediatrics · Nov 1993
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialA multicenter randomized trial comparing two surfactants for the treatment of neonatal respiratory distress syndrome. National Institute of Child Health and Human Development Neonatal Research Network.
To compare the efficacy of two surfactants, Exosurf Neonatal (Burroughs Wellcome Co.) and Survanta (Ross Laboratories), for the treatment of neonatal respiratory distress syndrome. ⋯ We found no difference between treatment groups in the incidence of death or bronchopulmonary dysplasia, although we did observe a difference in the initial response to treatment as measured by FIO2 and MAP.