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PubMed1990

Flow and volume dependence of respiratory system mechanics during constant flow ventilation in normal subjects and in adult respiratory distress syndrome.

Seven control subjects and seven patients with adult respiratory distress syndrome (ARDS) were artificially ventilated and flow, volume, and tracheal pressure were monitored. Respiratory system resistance (Rrs,max) was partitioned into its homogeneous (Rrs,min) and uneven (Rrs,u) components. Respiratory system elastance (Ers) was also measured. In both groups Ers did not vary with different inspiratory flows and volumes, but was significantly higher in ARDS. With increasing volume (isoflow maneuvers), Rrs,max and Rrs,u increased but Rrs,min remained unaltered in ARDS. In control patients, however, resistances did not vary but Rrs,max and Rrs,u were smaller and Rrs,min equaled their corresponding values in ARDS. Hence, stress relaxation seems to be increased in ARDS. During isovolume maneuvers Rrs,max and Rrs,u decreased with increasing flows (both groups), although they were significantly higher in ARDS. Rrs,min was not modified by different flows and was similar in both groups. Thus, pendelluft is also increased in ARDS. In conclusion, the mechanical profile of ARDS is characterized by increased Ers and Rrs,max, the latter being secondary to augmented mechanical unevenness within the system.

Adolescent↗
PubMed1992

Tumour necrosis factor in the bronchoalveolar secretions of infants with the respiratory distress syndrome and the effect of dexamethasone treatment.

BACKGROUND: Tumour necrosis factor alpha may contribute to the lung damage that occurs in the adult respiratory distress syndrome. Whether it occurs in the lungs of preterm infants with respiratory distress syndrome is unknown. METHODS: Tumour necrosis factor alpha concentrations in the bronchopulmonary secretions of 28 ventilated preterm infants were determined by the enzyme linked immunosorbent assay. RESULTS: Concentrations were low in the first three days of life, being undetectable in nine of the 20 infants whose bronchopulmonary secretions were sampled. From day 4 concentrations were increased and detectable in all but two of 14 infants. Similar concentrations were found in samples taken on days 8-20 and 21-40. Greater mean concentrations occurred in those infants requiring oxygen for a long time. In six infants who received dexamethasone treatment for prolonged ventilator dependency treatment was associated with a reduction in tumour necrosis factor alpha concentrations. CONCLUSIONS: Tumour necrosis factor may contribute to the neonatal respiratory distress syndrome, as suggested for the adult respiratory distress syndrome. The therapeutic effects of dexamethasone treatment in neonatal respiratory distress syndrome may be mediated, at least in part, by reduced production of pulmonary tumour necrosis factor.

Bronchoalveolar Lavage Fluid↗
PubMed1985

Isolated deafness following recovery from neurologic injury and adult respiratory distress syndrome. A sequela of intercurrent aminoglycoside and diuretic use.

We report two children who survived neurologic injury (near-drowning and Reye's syndrome) and adult respiratory distress syndrome and who required prolonged ventilatory support. Follow-up examination in both children showed steady neurologic recovery, but five months following discharge from their acute illness, profound hearing loss was diagnosed in both children. A review of the literature is reported and the hypothesis that combined aminoglycoside antibiotic and loop diuretic therapy caused the hearing loss is presented. Recommendation is made for audiologic assessment within six months of recovery from critical illness of pediatric patients in whom therapy has included loop diuretic and aminoglycoside antibiotic therapy.

Aminoglycosides↗
PubMed1975

[Prevention of respiratory distress syndrome with betamethasone. Preliminary communication].

A controlled trial of antepartum glucocorticoid treatment for prevention of respiratory distress syndrome in premature infants was carried out. 37 mothers, in whom premature delivery threatened between 28 and 37 weeks of gestation, were given intramuscular injections 8-12 mg of betamethasone as well as medication inhibiting uterine activity and strict bedrest to delay premature delivery for at least 24 to 48 hours. In comparison with a control group of 16 mothers, who received tocolytic and sedative medication and were on strict bedrest and another control group of 42 untreated patients, there was no difference in the 3 groups concerning the incidence of respiratory distress syndrome in premature infants, but there was a lower perinatal mortality rate of respiratory distress syndrome in the betamethasone treated group, than in the controls, possibly due to a milder course of respiratory distress syndrome disease by accelerating functional maturation of the fetal lung with betamethasone.

Apgar Score↗
PubMed1980

Adult respiratory distress syndrome related to ampicillin sensitivity.

A patient with the adult respiratory distress syndrome was found to have an alveolar allergic reaction demonstrated by transbronchial lung biopsy. The clinical course and subsequent skin test reactivity suggested ampicillin as the cause. This is an unusual presentation of ampicillin allergy, and drug sensitivity is suggested as another cause of the adult respiratory distress syndrome.

Adolescent↗
PubMed1976

Low thyroid hormones and respiratory-distress syndrome of the newborn. Studies on cord blood.

To investigate the relation between thyroid function and respiratory-distress syndrome we determined thyroid hormone in cord serum from 39 term and 120 premature newborns. In groups matched for gestational age (33 to 37 weeks) and body length, after exclusion of newborns with birth asphyxia, maternal diabetes and delivery by cesarean section, the newborns with respiratory distress syndrome had significantly lower cord tri-iodothyronine index, higher ratio of thyroxine to tri-iodothyronine and higher thyrotropin concentration than those without syndrome (P less than 0.05 or less). Conversely, the frequency and severity of respiratory-distress syndrome were higher in newborns who had low cord tri-iodothyronine and thyroxine concentration, low free tri-iodothyronine index and high thyrotropin levels. These observations show an association between low thyroid activity at birth and respiratory-distress syndrome and are in accord with animal studies showing accelerated lung maturation due to thyroxine administration.

Birth Weight↗
PubMed2006

Reversibility of lung collapse and hypoxemia in early acute respiratory distress syndrome.

RATIONALE: The hypothesis that lung collapse is detrimental during the acute respiratory distress syndrome is still debatable. One of the difficulties is the lack of an efficient maneuver to minimize it. OBJECTIVES: To test if a bedside recruitment strategy, capable of reversing hypoxemia and collapse in > 95% of lung units, is clinically applicable in early acute respiratory distress syndrome. METHODS: Prospective assessment of a stepwise maximum-recruitment strategy using multislice computed tomography and continuous blood-gas hemodynamic monitoring. MEASUREMENTS AND MAIN RESULTS: Twenty-six patients received sequential increments in inspiratory airway pressures, in 5 cm H(2)O steps, until the detection of Pa(O(2)) + Pa(CO(2)) >or= 400 mm Hg. Whenever this primary target was not met, despite inspiratory pressures reaching 60 cm H(2)O, the maneuver was considered incomplete. If there was hemodynamic deterioration or barotrauma, the maneuver was to be interrupted. Late assessment of recruitment efficacy was performed by computed tomography (9 patients) or by online continuous monitoring in the intensive care unit (15 patients) up to 6 h. It was possible to open the lung and to keep the lung open in the majority (24/26) of patients, at the expense of transient hemodynamic effects and hypercapnia but without major clinical consequences. No barotrauma directly associated with the maneuver was detected. There was a strong and inverse relationship between arterial oxygenation and percentage of collapsed lung mass (R = - 0.91; p < 0.0001). CONCLUSIONS: It is often possible to reverse hypoxemia and fully recruit the lung in early acute respiratory distress syndrome. Due to transient side effects, the required maneuver still awaits further evaluation before routine clinical application.

Adolescent↗
PubMed1992

Disordered pathways of fibrin turnover in lung lavage of premature infants with respiratory distress syndrome.

Premature infants who have self-limited respiratory distress syndrome (RDS) rapidly improve, whereas infants with a complicated respiratory course are more likely to develop bronchopulmonary dysplasia (BPD), a chronic lung disorder that is the result of prolonged lung injury and impaired healing. The balance of competing activities of coagulation and fibrinolysis may contribute to the premature lung's response to acute injury and determine, in part, whether there is early resolution or protracted alveolar inflammation. To determine the relative activities of the coagulation and fibrinolytic pathways in neonatal lung injury, procoagulant (PC) and plasminogen activator (PA) activities were measured in undiluted cell-free lung lavage samples obtained serially over the first 28 days of life from 11 infants with self-limited RDS, 11 infants with evolving BPD, and 5 mechanically ventilated control infants without lung disease. Lung lavage from all three groups contained readily detectable procoagulant activity due mainly to the tissue factor-Factor VII complex. Plasminogen activator activity was relatively high in control lavage samples but depressed on the first day of life in the two groups of infants with lung disease: median, 0.3814 IU/ml (control); 0.0541 IU/ml (RDS); and 0.0454 IU/ml (BPD), p < 0.05 in each case compared with control. Two infants with severe lung disease had no detectable plasminogen activator activity in lung lavage on the first day of life. Depressed fibrinolytic activity correlated with severity of lung disease assessed radiographically and by pulmonary function measurements. Plasminogen activator activity was due to both tissue plasminogen activator and urokinase.(ABSTRACT TRUNCATED AT 250 WORDS)

Apgar Score↗
PubMed1977

Long-term pulmonary sequelae of premature birth with and without idiopathic respiratory distress syndrome.

Seven children born prematurely who survived the respiratory distress syndrome, seven children born prematurely who had no neonatal lung disease, and seven normal children born at term were studied by comparison of flow volume curves obtained while breathing air to those obtained while breathing 80% helium and 20% oxygen. Expiratory flow rates in air both groups of prematurely born children were lower than flow rates of the children born at term, and the volumes of iso-flow were higher in the survivors of RDS than those of the children born at term. The differences in flow rates in air suggest an increase in large airway resistance in both groups of prematurely born children. It is speculated that this may be secondary to growth retardation related to prematurity. The elevated Viso V in the RDS group suggests an increase in small airway resistance secondary to the disease or to its therapy.

Airway Resistance↗
PubMed2003

Acute respiratory distress syndrome: an audit of incidence and outcome in Scottish intensive care units.

This prospective audit of incidence and outcome of the acute respiratory distress syndrome was conducted as part of the national audit of intensive care practice in Scotland. All patients with acute respiratory distress syndrome in 23 adult intensive care units were identified using the diagnostic criteria defined by the American-European Consensus Conference. Daily data collection was continued until death or intensive care unit discharge. Three hundred and sixty-nine patients were diagnosed with acute respiratory distress syndrome over the 8-month study period. The frequency of acute respiratory distress syndrome in the intensive care unit population was 8.1%; the incidence in the Scottish population was estimated at 16.0 cases.100,000(-1).year(-1). Intensive care unit mortality for acute respiratory distress syndrome was 53.1%, with a hospital mortality of 60.9%. In our national unselected population of critically ill patients, the overall outcome is comparable with published series (Acute Physiology and Chronic Health Evaluation II standardised mortality ratio = 0.99). However, mortality from acute respiratory distress syndrome in Scotland is substantially higher than in recent other series suggesting an improvement in outcome in this condition.

Adult↗
PubMed1999

The acute respiratory distress syndrome in children: recent UMMC experience.

The acute respiratory distress syndrome (ARDS) is now well recognized as a cause of respiratory failure in children and is associated with a high mortality rate. We retrospectively reviewed all cases of ARDS managed in our multidisciplinary pediatric intensive care unit (PICU) from 1994 to 1998 in order to identify predisposing conditions, outcomes, complications, recent trends in therapy, and resource utilization. Twenty-seven children were identified representing approximately 1% of all intensive care admissions. Sepsis was the most common predisposing illness and air leak complicated treatment in 60%. Mortality was 30% and was most often due to non-respiratory causes. High-frequency oscillatory ventilation (HFOV) was frequently utilized and felt to be beneficial in most cases. On average, survivors required mechanical ventilation for five weeks and hospitalization for nine weeks. We conclude that despite our comparatively low mortality rate, ARDS remains a significant challenge to the pediatric intensivist. We speculate that HFOV may be an important factor in reducing mortality.

Adolescent↗
PubMed1985

Idiopathic pulmonary fibrosis in adult respiratory distress syndrome. Diagnosis and treatment.

Ten consecutive patients who presented initially with adult respiratory distress syndrome, and who did not respond to conventional treatment, underwent open lung biopsy early in the course of their illness. Idiopathic pulmonary fibrosis was diagnosed and aggressive treatment with methylprednisolone sodium succinate and nutritional support was initiated. Eight patients survived and have not required long-term corticosteroid therapy. Previous reports have documented a mortality of greater than 85% with this particular syndrome of idiopathic pulmonary fibrosis in adult respiratory distress syndrome.

Adolescent↗
PubMed1996

Improved oxygenation utilizing a prone positioner in patients with acute respiratory distress syndrome.

OBJECTIVES: (a) To determine whether placing patients with acute respiratory distress syndrome in the prone position by a light-weight portable support frame improves oxygenation, (b) whether one can determine which patients benefit from prone positioning, and (c) to determine an effective technique for prone positioning of patients. DESIGN: Prospective, controlled trial without blinding. SETTING: Medical intensive care units in two urban university-affiliated hospitals. PATIENTS: Fifteen patients meeting a standard definition for acute respiratory distress syndrome were studied prospectively. Each patient acted as his own control for purposes of comparison. INTERVENTION: Patients were assigned randomly to begin in either supine or prone positions. The positioning frame was used to turn patients from one position to the other, and oxygenation, ventilation, respiratory mechanics, and hemodynamics were measured. RESULTS: Significantly better oxygenation was seen in the prone positions than in the supine (P < 0.05). In the overall population there was a decrease in AaDO2 of 21 mmHg when the patients were placed prone. The groups were then divided into responders (n = 9) and nonresponders (n = 6). There were significant differences between the groups (but not between positions) regarding PaO2, baseline, PaCO2, pulmonary artery pressures, and peak inspiratory pressures on the ventilator and in ICU length of stay and time on mechanical ventilatory support. CONCLUSION: Prone positioning improves oxygenation in the majority of patients studied and can be achieved relatively easily.

Adult↗
PubMedDate not supplied

[Acute respiratory distress syndrome in pediatric cardiosurgery].

The prognosis in acute respiratory distress syndrome (ARDS) is poor; its mortality is generally 40-60%. The mortality in patients with ARDS is more commonly associated with the sequels of sepsis and multiple organ dysfunction than with respiratory failure although the latest papers on protective ventilation suggest that death in these patients directly results from lung lesion in a number of cases. There have been encouraging data on the reduced mortality rates due to acute lung lesion/ARDS in the past decade. The development and introduction of new technologies of respiratory support, the emergence of new effective treatments for sepsis, and the improvement of general maintenance therapy in patients with ARDS may be a possible explanation for such changes for the best.

Cardiac Surgical Procedures↗
PubMed2006

Prolonged extracorporeal membrane oxygenation support for acute respiratory distress syndrome.

When all conventional treatments for respiratory failure in patients with acute respiratory distress syndrome (ARDS) have failed, extracorporeal membrane oxygenation (ECMO) can provide a chance of survival in these desperately ill patients. A 49-year-old male patient developed septic shock and progressive ARDS after liver abscess drainage. Venovenous ECMO was given due to refractory respiratory failure on postoperative day 6. Initially, two heparin-binding hollow-fiber microporous membrane oxygenators in parallel were used in the ECMO circuit. Twenty-two oxygenators were changed in the first 22 days of ECMO support because of plasma leak in the oxygenators. Each oxygenator had an average life of 48 hours. Thereafter, a single silicone membrane oxygenator was used in the ECMO circuit, which did not require change during the remaining 596 hours of ECMO. The patient's tidal volume was only 90 mL in the nadir and less than 300 mL for 26 days during the ECMO course. The patient required ECMO support for 48 days and survived despite complications, including septic shock, ARDS, acute renal failure, drug-induced leukopenia, and multiple internal bleeding. This patient received an unusually long duration of ECMO support. However, he survived, recovered well, and was in New York Heart Association functional class I-II, with a forced expiratory volume in 1 second of 81% of the predicted level 18 months later. In conclusion, ECMO can provide a chance of survival for patients with refractory ARDS. The reversibility of lung function is possible in ARDS patients regardless of the severity of lung dysfunction at the time of treatment.

Extracorporeal Membrane Oxygenation↗
PubMed1996

[The exogenous surfactant and its effect on the respiratory distress syndrome (RDS)].

In this article the pathophysiology and diagnosis of neonatal respiratory distress syndrome as a primarily form of surfactant deficiency is disclosed. Attention is paid to surfactant composition, productive and secretion in the alveoli and metabolic turnover as well. From clinical point the view basic principles concerning the surfactant replacement is discussed. Surfactant minimizes the surface tension and friction between the gas molecules and lung tissues during breathing. It also helps keep lung tissues dry and alveoli patent. At 26 to 28 weeks of gestation alveolar ducts and bronchioles are present but pulmonary capillaries are not in close contact with them. Alveoli may not even be distinguishable. Surfactant develops all through gestation but does not surge until about the 34th week. Infants born before 35 weeks of gestation are at risk for respiratory distress syndrome which is at first characterised by decrease of lung compliance. It leads to progressive respiratory failure.

Humans↗
PubMed1999

[Changes in the epidemiology of the acute respiratory distress syndrome (ARDS) in children].

OBJECTIVE: Our aim was to analyze, in a retrospective study, changes in acute respiratory distress syndrome (ARDS) within the same pediatric intensive care unit by using the same diagnostic criteria as published in 1982. PATIENTS AND METHODS: Fifteen patients (mean age 5.1 years, range 16 days-15 years) admitted between 1988 and 1994 fulfilling our former criteria for ARDS were included in the study. RESULTS: The incidence of ARDS after the age of 7 days was 0.45% of all admissions between the age of 1 week and 16 years vs 1.79% in the former series of patients (p < 0.001). Thus, the yearly rate of ARDS decreased from 5.7 to 2.1 cases per year. Six patients suffered a chronic underlying disease vs none in 1982 (p < 0.01). Triggering of ARDS by infection/inflammation was present in 14/15 patients vs 7/20 in the first series (p < 0.001). Except for the nadir PaO2/FiO2 ratio (54 mmHg vs 97 mmHg, p < 0.01), and duration of FiO2 > or = 0.5 (204 h vs 39 h, p < 0.01) there was no statistically significant difference with regard to respiratory data. Incidence of multiple organ/system failure and numbers of failing organs/systems remained unchanged. Eight of 15 patients died in the actual series vs 8/20 in 1982 (not significant). CONCLUSIONS: Compared to our former data, the incidence of ARDS has decreased. Although the number of patients with severe chronic disease has increased, mortality remains statistically unchanged. Infection/inflammation is currently the predominant event triggering ARDS. Judging by the PaO2/FiO2 ratio and duration of FiO2 > or = 0.5, pulmonary involvement is more severe. The number of failing organs/systems remains nearly twice as frequent in non-survivors compared to survivors.

Acute Disease↗