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PubMed1998

Experiences with high-frequency oscillatory ventilation in premature infants with respiratory distress syndrome.

BACKGROUND: High-frequency oscillatory ventilation (HFOV) has been used in treating premature infants with respiratory distress syndrome who have a low incidence of ventilation-associated lung injury. Herein, we report our initial clinical experience in using HFOV to treat such infants. METHODS: From October 1996 to February 1997, 10 premature infants with severe respiratory distress syndrome treated with HFOV were retrospectively evaluated. Clinical course and laboratory data collected during treatment were analyzed. Parameters evaluated included patient survival rate, incidence of chronic lung disease and morbidity associated with HFOV usage. RESULTS: The mean gestational age was 29 +/- 2 weeks; mean birth weight, 1,182 +/- 342 g; and mean period of HFOV treatment, 3.4 +/- 1.9 days. One patient died of sepsis due to infective pancarditis. Two patients developed moderate chronic lung disease at 30 days post delivery and in one of these patients, the disease persisted at 36 weeks' of age. The overall survival rate was 90%. No patient developed air-leak syndrome during the course of treatment. CONCLUSIONS: Our initial experience demonstrated that using HFOV in treating premature infants with severe respiratory distress syndrome was safe and effective. The incidence of moderate to severe chronic lung disease or air-leak syndrome following HFOV was low.

Female↗
PubMed1997

Effects of nebulized salbutamol on respiratory mechanics in adult respiratory distress syndrome.

OBJECTIVE: To determine whether nebulized salbutamol improves the respiratory mechanics of patients with adult respiratory distress syndrome (ARDS). We also assessed the mechanisms that contribute to high respiratory system resistances during this disease. PATIENTS AND SETTING: Eleven consecutive patients with ARDS without clinical evidence of chronic obstructive pulmonary disease, admitted to a polivalent intensive care unit, and mechanically ventilated with Siemens Elema Servo C ventilator at constant inspiratory flow. METHOD: Peak airway pressure (Ppeak), airway pressure immediately after end inspiratory occlusion (P1), plateau pressure (P2) and intrinsic positive end-expiratory pressure (PEEPi) were measured at baseline condition and then 5, 15, and 30 min after 1 mg of salbutamol had been administered via a nebulizer through the endotracheal tube. Partial pressure of arterial oxygen (PaO2), heart rate (HR) and mean blood pressure (BP) were monitored and minimal respiratory system resistances (Rrs, m), additional resistances (DRrs) and static compliance (Cst) were computed. RESULTS: Between baseline and post-salbutamol, we observed changes in Ppeak, P1, P2, PEEPi and Rrs, m. As there were no significant differences between values at the different intervals during post administration, the results are described comparing baseline and 15 min post-salbutamol administration values. We found a significant decrease in Ppeak (4.9 +/- 0.8 cmH2O). P1 (3 +/- 0.6 cmH2O). P2 (2.1 +/- 0.6 cmH2O), PEEPi (1.9 +/- 0.5 cmH2O) and Rrs, m (1.9 +/- 0.3 cmH2O/1 s-1); DR, rs decreased in five patients, did not change in four and increased in two. HR, PaO2 and BP did not change. CONCLUSIONS: a) Salbutamol administered through the endotracheal tube by a nebulizer device lessens respiratory system resistances and airway and alveolar pressures, and therefore could decrease the risk of barotrauma and alveolar damage; b) high respiratory system resistances in ARDS have an increased smooth muscle tone component that can be reversible with salbutamol.

Adult↗
PubMed1990

Fulminant adult respiratory distress syndrome after suction lipectomy. A case report.

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. Aggressive haemodynamic and respiratory support over an 8-day period resulted in patient survival. 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.

Adult↗
PubMed1996

[Gas exchange and hemodynamic effects of nitric oxide inhalation in patients with acute respiratory distress syndrome].

BACKGROUND: To analyze the effects on gas exchange and hemodynamics of nitric oxide inhalation in patients with acute respiratory distress syndrome. PATIENTS AND METHODS: Prospective study including 16 acute respiratory distress syndrome patients. We analyzed the acute and short-term (5 days) effects of inhaling 5 parts per million (ppm) nitric oxide on gas exchange and hemodynamics. RESULTS: After nitric oxide inhalation, PaO2/FiO2 ratio changed from 81 +/- 25 to 126 +/- 57 mmHg (p = 0.0001), mean pulmonary artery pressure decreased from 30.1 +/- 8.2 to 27.3 +/- 6.6 mmHg (p = 0.002), intrapulmonary shunt decreased from 44.6 +/- 11% to 34.1 +/- 7.9% (p = 0.002) and cardiac index did not change. Thirteen out of 16 patients (81.2%) presented at least a 20% improvement in PaO2/FiO2 ratio. In the 10 patients treated over 5 consecutive days, we observed that those who improved (increase in PaO2/FiO2 ratio higher than 20% after inhaling 5 ppm nitric oxide) showed a lower cardiac index, a higher mean pulmonary artery pressure and a higher pulmonary vascular resistance index than those who did not: Cl 3.9 +/- 0.81 vs 4.9 +/- 0.81 l/min/m2 (p < 0.001), mean pulmonary artery pressure 32.4 +/- 7 vs 25.3 +/- 4.2 mmHg (p = 0.001), and pulmonary vascular resistance index 421 +/- 199 vs 241 +/- 106 dyn.s.cm5/m2 (p = 0.003). Mean levels of methemoglobin were 1.1 +/- 0.24% (range: 0.4-1.6%), and NO2 concentration was always lower than 100 parts per billion. CONCLUSIONS: Low doses of inhaled nitric oxide induce a selective pulmonary vasodilatation and significant improvement of oxygenation in the majority of acute respiratory distress syndrome patients, although those with a hyperkinetic hemodynamic status are less likely to improve the oxygenation. These effects are maintained for at least 5 days. We did not observe rebound effects.

Acute Disease↗
PubMed1995

Adult respiratory distress syndrome and artificial surfactant replacement in the pediatric patient.

Adult respiratory distress syndrome (ARDS) frequently develops after near-drowning, smoke inhalation, burns, blunt trauma to chest, and overwhelming sepsis. Surfactant depletion, inactivation or destruction by the accumulation of proteinaceous material in the alveoli, and changes in the relative composition of phospholipids or protein component have been associated with ARDS. Artificial surfactant reverses these changes in experimental animals. Seven cases of ARDS have been treated on an experimental basis with artificial surfactant after approval and in accordance with ethical standards of the institution's committee on human experimentation. Informed consent was obtained from parents prior to administering artificial surfactant. We identified five cases of ARDS in retrospective analysis and used them as historical controls. Mortality between these two groups was analyzed with Fisher's exact test. One of seven (14.2%) children treated with surfactant died of overwhelming infection, and 2/5 (40%) of the historical controls died of pulmonary causes (P = 0.523). Statistically, surfactant therapy did not improve survival in patients with ARDS; however, ARDS patients receiving surfactant improved in their pulmonary dynamic compliance and had a tendency to stabilize earlier in gas exchange, allowing us to decrease ventilatory support.

Child↗
PubMed2001

Agreement between alternative classifications of acute respiratory distress syndrome.

To examine the agreement between two classifications of acute respiratory distress syndrome (ARDS) that are used interchangeably in clinical practice and clinical research, we classified 118 patients taking part in a randomized trial with respect to the presence of ARDS using the North American-European Consensus Committee (NAECC) and the Lung Injury Severity Score (LISS) criteria. The incidence of ARDS using NAECC criteria was 55.1% (95% confidence interval, 46.1% to 64.1%), and using the LISS criteria 61.9% (95% confidence interval, 53.1% to 70.6%). The p value on the difference between these proportions was 0.07. Raw agreement, chance-corrected agreement (kappa), and chance-independent agreement (phi) on the study occurrence of ARDS using the two classifications were, respectively, 0.73 (95% CI, 0.65 to 0.81), 0.46 (95% CI, 0.32 to 0.61), and 0.63 (95% CI, 0.41 to 0.79). No single component of either index contributed to disagreement to an appreciably greater extent than other components. Baseline characteristics and outcomes were similar among patients who developed ARDS according to either classification. We conclude that NAECC and LISS classifications resulted in similar estimates of the incidence of ARDS in this clinical trial, though patients were frequently classified as having ARDS with only one model. These discordant classifications had no prognostic importance.

Adult↗
PubMed1985

[Acute respiratory distress syndrome of the adult].

In a 43-year-old female patient after a bland influenzal infection suddenly an acute life-threatening picture of a disease with severe dyspnoea developed. Radiologically a distinct interstitial oedema was to be seen. According to the clinical and paraclinical data the case in question was the benign for of an acute dyspnoea syndrome of the adult. Etiology and therapy of the acute dyspnoea syndrome are shown. This picture of a disease should be included into the differential-diagnostic consideration in acute conditions of dyspnoea.

Adult↗
PubMed2005

Acute respiratory distress syndrome in a child with Kawasaki disease.

This report presents a case of classic Kawasaki disease with progression to acute respiratory distress syndrome. The severity of the patient's pulmonary disease led clinicians to suspect toxic shock syndrome. Clinicians need to be aware that pulmonary manifestations of Kawasaki disease can include acute respiratory distress syndrome.

Child, Preschool↗
PubMed1988

The association of adult respiratory distress syndrome (ARDS) with thoracic irradiation (RT).

The authors report two cases of apparent adult respiratory distress syndrome (ARDS) following limited thoracic irradiation for lung cancer. Respiratory failure followed rapidly after irradiation with diffuse bilateral infiltrates, both in and out of the irradiated volume along with progressive hypoxemia unresponsive to oxygen management. Other potential causes of lung injury such as lymphangitic tumor, cardiac failure, and infections were excluded by both premortem and postmortem examination. Autopsy findings in both irradiated and unirradiated volumes of lung were consistent with hyaline membrane changes. The possible relationship between radiation therapy to limited lung volumes and the development of adult respiratory distress syndrome is discussed.

Carcinoma, Squamous Cell↗
PubMed1990

[Acute respiratory distress syndrome in the initial phase of myocardial infarction in adults].

Four patients developed an acute respiratory distress syndrome characterised by clinical and radiological signs of pulmonary oedema, a protein-rich oedema, severe hypoxemia refractory to oxygen therapy, contrasting with normal left ventricular filling pressures and indicating increased permeability of the alveolo-capillary membrane, 24 to 72 hours after the onset of acute myocardial infarction. After having excluded the usual causes of the acute respiratory distress syndrome, the authors suggest that acute myocardial infarction, especially when extensive, may cause a lesion of the alveolo-capillary membrane by an unknown mechanism. Treatment consisted in mechanical ventilation with positive expiratory pressures in 3 cases and with continuous positive pressure during spontaneous respiration in the third patient and in relay with controlled ventilation in the other two. These techniques of ventilation improved the hypoxemia and led to complete cure in all cases without evolution to pulmonary fibrosis. In addition to mechanical ventilation, all patients were given systematic antibiotic therapy because of the possibility of an infectious etiology while waiting for the results of microbiological and serological testing and because of the high risk of superinfection which plays an essential part in the outcome of the condition. The immediate response to treatment was favourable in all cases. One patient died suddenly of cardiogenic shock two weeks after this episode. The other patients are still alive 39, 38 and 20 months after infarction. The importance of the diagnosis of the acute respiratory distress syndrome in the acute phase of myocardial infarction resides in its therapeutic implications which are quite different to those of cardiogenic shock.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed2000

Permissive hypercapnia impairs pulmonary gas exchange in the acute respiratory distress syndrome.

Current recommendations for mechanical ventilation in the acute respiratory distress syndrome (ARDS) include the use of small tidal volumes (VT), even at the cost of respiratory acidosis. We evaluated the effects of this permissive hypercapnia on pulmonary gas exchange with the multiple inert gas elimination technique (MIGET) in eight patients with ARDS. After making baseline measurements, we induced permissive hypercapnia by reducing VT from 10 +/- 2 ml/kg to 6 +/- 1 ml/kg (mean +/- SEM) at constant positive end-expiratory pressure. After restoration of initial VT, we infused dobutamine to increase cardiac output (Q) by the same amount as with hypercapnia. Permissive hypercapnia increased Q by an average of 1.4 L. min(-)(1). m(2), decreased arterial oxygen tension from 109 +/- 10 mm Hg to 92 +/- 11 mm Hg (p < 0.05), markedly increased true shunt (Q S/Q T), from 32 +/- 6% to 48 +/- 5% (p < 0.0001), and had no effect on the dispersion of VA/Q.VA/Q. On reinstatement of baseline V T with maintenance of a high Q, Q S/Q T remained increased, to 38 +/- 6% (p < 0.05), and Pa(O(2 ))remained decreased, to 93 +/- 4 mm Hg (p < 0. 05). These results agreed with effects of changes in VT and Q predicted by the mathematical lung model of the MIGET. We conclude that permissive hypercapnia increases pulmonary shunt, and that deterioration in gas exchange is explained by the combined effects of increased Q and decreased alveolar ventilation.

Adolescent↗
PubMed1991

Synthetic vs human surfactants in the treatment of respiratory distress syndrome: radiographic findings.

Exosurf, a synthetic surfactant, was instilled endotracheally in 49 neonates as treatment for respiratory distress syndrome. The radiologic courses of these neonates were compared with the courses of 18 neonates previously treated with human surfactant and of 18 untreated neonates. The radiologic severity of respiratory distress syndrome decreased significantly in neonates treated with Exosurf compared with that in untreated neonates. Radiologic improvement in those treated with Exosurf was slightly delayed when compared with the improvement of age-matched neonates treated with human surfactant. Otherwise no significant difference was noted between Exosurf and human surfactant in radiologic severity of respiratory distress syndrome or in the prevalence of pulmonary interstitial emphysema, pneumothorax, and bronchopulmonary dysplasia. These findings support the thesis that artificial surfactant is an acceptable substitute for surfactants of biological origin, with possible benefits of safety and ease of use.

Bronchopulmonary Dysplasia↗
PubMed1989

Impact of antenatal dexamethasone administration on respiratory distress syndrome in surfactant-treated infants.

Neonatal lung disease is primarily responsible for the perinatal morbidity and mortality associated with preterm birth. Recently exogenous surfactant replacement therapy has been used to prevent or treat respiratory distress syndrome. As part of a multicenter, preventive trial between February 1986 and December 1988 using calf-lung surfactant extract, we treated 147 infants with single dose calf-lung surfactant extract. We analyzed this experience to evaluate the possibility that antenatal steroids may be additive (with calf-lung surfactant extract) in reducing both the incidence and severity of respiratory distress syndrome. Although a reduction in the incidence of respiratory distress syndrome was observed among the 33 neonates exposed to antenatal dexamethasone when compared with the 114 infants given calf-lung surfactant extract alone, the difference was not significant (37.7% vs. 24.2% p = 0.15). However, comparison of neonatal subsets previously shown to benefit most from steroid use revealed an additive effect between calf-lung surfactant extract and dexamethasone in reducing both the incidence and severity of respiratory distress syndrome. Of the 99 singleton pregnancies, only 2 of 16 infants treated with calf-lung surfactant extract and dexamethasone developed respiratory distress syndrome, compared with the 33 of 83 calf-lung surfactant extract cases (p less than 0.05). A similar reduction was observed in infants between 28 and 32 weeks' gestation (calf-lung surfactant extract, 21 of 79 vs. calf-lung surfactant extract and dexamethasone, 0 of 24; p less than 0.05). A reduction in disease severity was observed in male offspring (moderate or severe respiratory distress syndrome only; 22 of 63 vs. 2 of 22; p less than 0.05). Potential confounding variables (e.g., gestational age at birth, birth weight, exposure to tocolytics before delivery, fetal pH at birth) were similar in all comparisons. We conclude that an additive effect between dexamethasone and calf-lung surfactant extract is observed in selected cases. It may therefore be appropriate to maximize antenatal steroid use in centers where exogenous surfactant is available.

Acid-Base Equilibrium↗
PubMedDate not supplied

[Prone position in adult respiratory distress syndrome: nursing care].

The use of prone position in patients with Adult Respiratory Distress Syndrome is becoming a more and more habitual therapeutic measure in the units of Intensive Care, for what to have appropriate Nursing protocols will improve our professional performances. This article seeks to modernize knowledge by means of the practical experience and the bibliographical revision about Adult Respiratory Distress Syndrome, of the prone position and its effects on the organism, as well as the prone technique and the Nursing cares of the patients in prone position. It is propounded a detailed technique in steps, to carry out the prone position in a sure way, an itemized revision on the posture of the patient's maintenance in prone position and a Nursing cares protocol for the patients located in this posture.

Humans↗
PubMed2006

Neuromuscular blocking agents decrease inflammatory response in patients presenting with acute respiratory distress syndrome.

OBJECTIVE: To evaluate the effects of neuromuscular blocking agents (NMBAs) on pulmonary and systemic inflammation in patients with acute respiratory distress syndrome ventilated with a lung-protective strategy. DESIGN: Multiple-center, prospective, controlled, and randomized trial. SETTING: One medical and two medical-surgical intensive care units. PATIENTS: A total of 36 patients with acute respiratory distress syndrome (Pao2/Fio2 ratio of < or =200 at a positive end-expiratory pressure of > or =5 cm H2O) were included within 48 hrs of acute respiratory distress syndrome onset. INTERVENTIONS: Patients were randomized to receive conventional therapy plus placebo (n = 18) or conventional therapy plus NMBAs (n = 18) for 48 hrs. Both groups were ventilated with a lung-protective strategy (tidal volume between 4 and 8 mL/kg ideal body weight, plateau pressure of < or =30 cm H2O). MEASUREMENTS AND MAIN RESULTS: Bronchoalveolar lavages and blood samples were performed, before randomization and at 48 hrs, to determine the concentrations of tumor necrosis factor-alpha, interleukin (IL)-1beta, IL-6, and IL-8. Pao2/Fio2 ratio was evaluated before randomization and at 24, 48, 72, 96, and 120 hrs. A decrease over time in IL-8 concentrations (p = .034) was observed in the pulmonary compartment of the NMBA group. At 48 hrs after randomization, pulmonary concentrations of IL-1beta (p = .005), IL-6 (p = .038), and IL-8 (p = .017) were lower in the NMBA group as compared with the control group. A decrease over time in IL-6 (p = .05) and IL-8 (p = .003) serum concentrations was observed in the NMBA group. At 48 hrs after randomization, serum concentrations of IL-1beta (p = .037) and IL-6 (p = .041) were lower in the NMBA group as compared with the control group. A sustained improvement in Pao2/Fio2 ratio was observed and was reinforced in the NMBA group (p < .001). CONCLUSION: Early use of NMBAs decrease the proinflammatory response associated with acute respiratory distress syndrome and mechanical ventilation.

Cytokines↗
PubMed2005

[Risk factors for mortality in very low birth weight infants with respiratory distress syndrome].

INTRODUCTION: In the last few years the life expectancy of very low birth weight (VLBW) infants has improved. When these patients have respiratory distress syndrome, it is difficult to know with any certainty which factors have the greatest influence on mortality. The aim of this study was to determine which variables, among a series, have the greatest influence on mortality from a multivariate perspective. PATIENTS AND METHODS: A sample of 209 VLBW infants born over a long period (15 years and 7 months) was studied. The following variables were analyzed: date of birth, degree of respiratory distress syndrome, sex, birth weight, weeks of gestation, born within or elsewhere, prenatal corticoid administration, type of gestation, type of delivery, amniorrhexis time, Apgar test at 1 and 5 minutes, surfactant administration, hours of life at which the first dose of surfactant was administered, and early sepsis. A multiple logistic regression analysis was developed using Hosmer-Lemeshow methodology. RESULTS: The following variables were identified as significant: birth weight, Apgar test at 5 minutes, prenatal corticoids, degree of respiratory distress syndrome, and surfactant administration. The remaining variables were less important in the multivariate analysis. CONCLUSIONS: Higher birth weight and Apgar score at 5 minutes, prenatal corticoid and surfactant administration, and a lower degree of respiratory distress syndrome reduce mortality. The logistic regression model used quantifies how these factors behave and allows the probability of mortality in VLBW infants with respiratory distress syndrome to be estimated.

Female↗
PubMed1997

Nitric oxide has little effect on acute pulmonary hypertension and right ventricular function during acute respiratory distress syndrome.

OBJECTIVE: To evaluate the effect of nitric oxide (NO) on acute pulmonary hypertension and right ventricular function in patients with acute respiratory distress syndrome. DESIGN: A prospective clinical study. PATIENTS: Ten patients in the respiratory and surgical intensive care units were used. They met the criteria for acute respiratory distress syndrome and were significantly hypoxic. They were all ventilator-dependent at the time of the study. INTERVENTION: NO was delivered to the patients in 5, 10, 20 and 30 ppm doses for 30 minutes at each concentration. The dosing was not randomised. MEASUREMENTS AND RESULTS: The general and central haemodynamics were measured. Right ventricular function and interaction with the pulmonary artery impedance (Ea) were quantified with the ratio of right ventricular stroke work index/Ea. NO did not decrease the raised pulmonary artery pressure found in all of the patients. Right ventricular coupling to the circulation did not improve during the administration of NO. CONCLUSION: NO did not relieve the acute pulmonary artery hypertension associated with acute respiratory distress syndrome. As a consequence of this, right ventricular function failed to improve during the administration of NO.

Acute Disease↗