Articles: respiratory-distress-syndrome.
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Comparative Study Clinical Trial
Comparison of the effects of intravenous almitrine and positive end-expiratory pressure on pulmonary gas exchange in adult respiratory distress syndrome.
The effects of almitrine on pulmonary gas exchange and haemodynamics were compared to those of positive end-expiratory pressure (PEEP) in 10 patients with a severe adult respiratory distress syndrome (ARDS) who required continuous mechanical ventilation. Haemodynamic and gas exchange measurements were made before and after 30 min of PEEP at a level of 10 cmH2O, then 30 min later, before and at the end of the intravenous infusion of almitrine at a dose of 0.25 mg.kg-1 in 30 min. There was no significant difference between baseline gas exchange and haemodynamic parameters. ⋯ Neither PEEP nor almitrine caused a significant change in arterial carbon dioxide tension (PaCO2). The haemodynamic parameters did not change significantly with almitrine, whereas mean systemic arterial pressure decreased from 85.4 to 81.1 mmHg (p less than 0.05) with PEEP. These results are consistent with the hypothesis that both treatments improve ventilation/perfusion (VA/Q) distributions, by an increase in functional residual capacity in the case of PEEP and a redistribution of pulmonary perfusion in the case of almitrine.
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Sixteen trauma victims with adult respiratory distress syndrome were retrospectively examined. High injury severity score (mean: 44), massive transfusion requirements, and prolonged ventilator days characterize this group. Persistent intra-abdominal infection accounted for two of three deaths in this series. ⋯ High frequency jet ventilation was necessary in one subject. Two patients exhibited early ARDS reversal, ie, clinical improvement, better chest x-ray and decreased shunt (within 72 hours) when an intra-abdominal septic focus was eradicated. Principles of critical care for these patients remain: an FiO2 less than .40, limiting barotrauma, using PEEP for alveolar recruitment and close monitoring of O2 transport.
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Critical care medicine · Jun 1991
Oxygen delivery-dependent oxygen consumption in acute respiratory failure.
To investigate whether oxygen consumption (VO2) is dependent on oxygen delivery (DO2) in adult respiratory distress syndrome (ARDS) and non-ARDS acute respiratory failure. ⋯ VO2 is dependent on DO2 over a wide range of DO2 values in acute respiratory failure. This dependency phenomenon is much stronger in ARDS than in respiratory failure due to other causes. Due to the abnormal dependency of VO2 on DO2, changes in the oxygenation status may not be reflected by changes in mixed venous oxygen saturation in ARDS.
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Critical care medicine · May 1991
Use of continuous noninvasive measurement of oxygen consumption in patients with adult respiratory distress syndrome following shock of various etiologies.
To describe the patterns of cardiac index, oxygen delivery (DO2), oxygen consumption (VO2), and oxygen deficit (or excess) and to compare invasive and noninvasive monitoring systems for evaluation of these oxygen transport patterns. ⋯ Monitoring of VO2 and DO2 variables is useful for evaluation of tissue oxygenation and titration of therapy in critically ill patients. Noninvasive monitoring of VO2 values are in good agreement with VO2 values calculated from invasive measurements of cardiac index. The increased DO2 and VO2 values are not attributable to mathematical coupling of erroneous cardiac index values.
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Critical care medicine · May 1991
ReviewOxygen transport in adult respiratory distress syndrome and other acute circulatory problems: relationship of oxygen delivery and oxygen consumption.
To evaluate the evidence that oxygen consumption (VO2) is pathologically dependent on oxygen delivery (DO2). ⋯ Pathologic dependence of VO2 on DO2, especially the inability to increase tissue oxygen extraction, is present in most patients with ARDS and many other critically ill individuals. PVO2 and CVO2 are both unreliable indicators of cardiac output, DO2, or VO2.