Articles: respiratory-distress-syndrome.
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Clinics in chest medicine · Dec 1990
ReviewPulmonary pathology of the adult respiratory distress syndrome.
Lung morphology in ARDS reflects the rapid evolution from interstitial and alveolar edema to end-stage fibrosis consequent to injury of the alveolocapillary unit. This morphologic progression, termed diffuse alveolar damage, has been subdivided into sequentially occurring exudative, proliferative, and fibrotic phases. Pulmonary lesions correlate with the phase of alveolar damage rather than with its specific cause. ⋯ It must be re-emphasized that the lung is stereotyped in its response to injury, and, consequently, descriptive, or even quantitative, studies of lung morphology can only provide clues regarding the initiating factors and pathogenetic mechanisms of ARDS. Progress in understanding the pathogenesis of ARDS and the devising of rational approaches to therapy will ultimately depend on careful clinical and experimental studies that unravel basic mechanisms of cellular injury and response. The course of these investigations must be guided by and constantly correlated with the pathologic features that occur in humans.
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Clinics in chest medicine · Dec 1990
ReviewLung mechanics in the adult respiratory distress syndrome. Recent conceptual advances and implications for management.
Since the earliest description of the adult respiratory distress syndrome (ARDS), impaired lung compliance has been a key diagnostic feature. Newer data suggest that a clear understanding of the mechanisms of acute lung injury may be needed to select the ventilatory pressures and patterns of flow delivery required for optimal gas exchange, adequate oxygen supply to tissue, and avoidance of barotrauma. This discussion briefly reviews the ARDS-specific derangements of lung mechanisms, describes measurement techniques applicable to the clinical setting, and suggests ways in which such information can be used in patient management.
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In cancer patients, respiratory distress may be due to cancer directly, to cancer complications, to cancer treatment complications or unrelated diseases. Based on the identification of the mechanism and cause of the dyspnea, therapy that will be given in a critical care unit, will be both etiological and supportive. It will take into account the prognosis of the underlying neoplastic disease.
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The adult respiratory distress syndrome developing within 24 hours in a patient who underwent suction lipectomy for body contouring under general anaesthesia is reported. During surgery, in which a total of 1.3 l of suction matter was removed, the patient became haemodynamically unstable and mildly hyperthermic. Subsequently, clinical signs and symptoms of the fat embolism syndrome developed. ⋯ Malignant hyperthermia was excluded as cause for the clinical presentation on muscle biopsy and in vitro caffeine contracture studies. Although usually complication-free, suction lipectomy may be associated with life-threatening incidents. Even suction volumes as low as 1.3 l have potential hazards, therefore the procedure merits regular postoperative observation and re-assessment.
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Most reports describe reduction in proximal airway pressures with high-frequency jet ventilation. This led us to speculate that high-frequency jet ventilation might reduce barotrauma by providing alveolar ventilation at lower airway pressures. We describe a group of patients in whom a high incidence of barotrauma was observed after institution of high-frequency jet ventilation despite reduction in measured airway pressures. ⋯ Five patients had bilateral pneumothorax and three developed tension pneumothorax. Despite reductions in proximal airway pressures, barotrauma is a significant potential complication of high-frequency jet ventilation in patients with noncompliant lungs. We currently place bilateral prophylactic thoracostomy tubes in patients with adult respiratory distress syndrome prior to initiation of high-frequency jet ventilation.