Articles: respiratory-distress-syndrome.
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Critical care medicine · Oct 1982
Left ventricular contractility using isovolumic phase indices during PEEP in ARDS patients.
The effects of incremental increases in PEEP during mechanical ventilation on left ventricular (LV) contractility before and after intravascular volume expansion (IVE) were studied in 10 patients treated for ARDS. A pulmonary artery (PA) catheter, a LV catheter-tip micromanometer, and an esophageal balloon catheter were inserted in these patients. We measured transmural right atrial and PA pressures, transmural LV end-diastolic and systemic arterial pressures, the first derivative of LV pressure (LV dP/dt), the ratio of LV dP/dt at transmural developed LV pressure (dP/dt/DPt) with DPt = 5, 10, 40 mm Hg, cardiac index (CI) at every level of PEEP and after IVE at the highest PEEP. ⋯ IVE reversed this fall in CI and peak dP/dt. Whereas transmural LV end-diastolic pressure rose markedly. We conclude that the observed fall in LV performance during PEEP is not the result of a depressed LV contractility because PEEP does not induce a decrease in dP/dt/DPt, the least sensitive to change in preload isovolumic phase indices of contractility.
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Tokai J. Exp. Clin. Med. · Sep 1982
Measurement of functional residual capacity and pulmonary carbon monoxide diffusing capacity during mechanical ventilation with PEEP.
First, our new simplified method to measure FRC and DLCO simultaneously during mechanical ventilation was described in detail. Secondly, we applied the method to ARDS patients and observed the effects of PEEP on arterial blood gases (ABGs), FRC and DLCO of these patients. ⋯ DLCO/FRC remained unchanged, although DLCO increased with PEEP. We concluded that the dissociation of FRC and ABG data in a group of patients could be caused by wasted ventilation which might be attributed to VA/Q unevenness.
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Adult respiratory distress syndrome is becoming more frequent in pediatric age. There are several factors involved in its' etiology. Sepsis is almost invariably present in all patients. ⋯ The extracorporeal oxygenation guarantees the oxygen exchange but it does not affect survival. Mortality is 95%. Patients who survive have minimal pulmonary sequelae.