Articles: respiratory-distress-syndrome.
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Acta Anaesthesiol Scand Suppl · Jan 1991
Extracorporeal carbon dioxide removal performed with surface-heparinized equipment in patients with ARDS.
To avoid the drawbacks of systemic anticoagulation during prolonged extracorporeal circulation in patients with adult respiratory distress syndrome (ARDS) a heparinization technique has been developed by which partially degraded heparin can be covalently end-point attached to the surface of the equipment constituting the extracorporeal circuit (Carmeda Bio-Active Surface, CBAS) thereby localizing the anticoagulatory effect. Since 1986 we have used extracorporeal circuits and membrane lungs coated with the CBAS for extracorporeal lung assistance (ECLA) in 14 patients suffering from ARDS. The patients were on ECLA for 3 to 55 days with a survival rate of 43%. Our experience so far is that by using equipment coated with CBAS it is possible to perform long-term extracorporeal circulation with a minimum of intravenously administered heparin, thus avoiding the risk of major coagulation defects.
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Pediatric pulmonology · Jan 1991
Effect of positive end-expiratory pressure on respiratory compliance in children with acute respiratory failure.
We studied the effect of positive end-expiratory pressure (PEEP) on the compliance of the respiratory system (Crs) in 25 children (age, 3 weeks to 10 years) requiring mechanical ventilation. Functional residual capacity (FRC) measurements were performed at 2 cm H2O increments, from 0 to 18 cm H2O of PEEP, and the FRC values were regressed versus PEEP. Static Crs, Crs/kg, and specific compliance (Crs/FRC) were calculated for each PEEP level. ⋯ We concluded that static respiratory compliance improves in most (but not all) children with acute respiratory failure when FRC is normalized. Static respiratory compliance reaches maximum levels at PEEP values that are close (but not equal) to those that result in FRC normalization. Thus, assessment of the effect of PEEP on compliance is required in individual patients.
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Serial pulmonary function tests were performed in 13 preterm infants with severe RDS and 16 premature neonates with healthy lungs (8 intubated because of hypovention after birth, 8 were breathing spontaneously). Airflow was measured by a pneumotachograph, pressure changes were determined by airway pressure in ventilated infants or esophageal pressure in spontaneously breathing neonates. Pulmonary mechanics were calculated by a computerized system (PEDS/Medical Associated Services, Hatfield, Pennsylvania). ⋯ In the course of the disease, improvement in gas exchange preceded increase of compliance. Intraindividual comparisons in the acute and recovery phase of RDS and in infants with normal lungs showed higher values for compliance and lower values for airway pressure and resistance during spontaneous breaths. The differences between dynamic compliance of the respiratory system measured during mechanical ventilation, and dynamic lung compliance recorded during spontaneous breaths are due to influences of the respirator on the infant's lung.
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Clinics in chest medicine · Dec 1990
ReviewSepsis syndrome, the adult respiratory distress syndrome, and nosocomial pneumonia. A common clinical sequence.
Systemic sepsis and pneumonia are common predisposing factors for ARDS, which can serve as the initial manifestation of the multisystem organ failure syndrome. Primary pneumonia that necessitates ICU admission leads to ARDS in approximately 10% of patients. Systemic infection can also lead to ARDS, but when bacteremia alone is present, the risk is low (probably less than 5%). ⋯ This infection appears to add to the propagation of the multiple system organ failure that has already begun. In the future, it may become possible to prevent this infection, which would be a welcome development, because currently, we are stymied in our efforts to diagnose and treat pneumonia in the setting of acute lung injury. Preventive efforts will follow from an understanding of the pathogenesis of pneumonia and in the future may include topical antibiotics, selective digestive decontamination, and prophylactic passive immunotherapy.