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Acute Respiratory Distress Syndrome in Children  [cached]
Dincer Yildizdas,Ozden Ozgur Horoz,Ali Ertug Arslankoylu,Muge Sagiroglu
Arsiv Kaynak Tarama Dergisi , 2009,
Abstract: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are an important challenge for pediatric intensive care units. These disorders are characterized by a significant inflammatory response to a local (pulmonary) or remote (systemic) insult resulting in injury to alveolar epithelial and endothelial barriers of the lung, acute inflammation and protein rich pulmonary edema. The reported rates in children vary from 8.5 to 16 cases/1000 pediatric intensive care unit (PICU) admissions. The pathological features of ARDS are described as passing through three overlapping phases-an inflammatory or exudative phase (0-7 days), a proliferative phase (7-21 days) and lastly a fibrotic phase. The treatment of ARDS rests on good supportive care and control of initiating cause. Ventilatory modes and nursing interventions to optimize patient outcomes are identified. The goal of ventilating patients with ALI/ARDS should be to maintain adequate gas exchange. Lung protective mechanical ventilation with optimal lung recruitment is the mainstay of supportive therapy. This can be achieved by use of optimum PEEP, low tidal volume and appropriate FiO2. New therapeutic modalities refer to corticosteroid, high frequency ventilation, inhaled nitric oxide, prone positioning and surfactant treatment. Well-designed follow up studies are needed. [Archives Medical Review Journal 2009; 18(4.000): 241-259]
Ajuste a la ventilación mecánica guiado por curvas presión-volumen de flujo lento en pacientes con síndrome de distress respiratorio agudo e injuria pulmonar aguda Mechanical ventilatory parameters guided by the low flow pressure-volume curve in patients with acute lung injury/acute respiratory distress syndrome  [cached]
Vinko Tomicic F,Jorge Molina B,Jerónimo Graf S,Mauricio Espinoza R
Revista médica de Chile , 2007,
Abstract: Background: Mechanical ventilation may contribute to lung injury and then enhance systemic inflammation. Optimal ventilatory parameters such as tidal volume (V T) and positive end expiratory pressure (PEEP) can be determined using different methods. Low flow pressure volume (P/V-LF) curve is a useful tool to assess the respiratory system mechanics and set ventilatory parameters. Aim: To set V T and PEEP according P/V-LF curve analysis and evaluate its effects on gas exchange and hemodynamic parameters. Materials and methods: Twenty seven patients underwent P/V-LF within the first 72 hours of acute lung injury/acute respiratory distress syndrome (ALI/ARDS). P/V-LF curves were obtained from the ventilator and both lower and upper inflexion points determined. Gas exchange and hemodynamic parameters were measured before and after modifying ventilator settings guided by P/V-LF curves. Results: Ventilatory parameters set according P/V-LF curve, led to a rise of PEEP and reduction of V T: 11.6±2.8 to 14.1±2.1 cm H2O, and 9.7±2.4 to 8.8±2.2 mL/kg (p <0.01). Arterial to inspired oxygen fraction ratio increased from 158.0±66 to 188.5±68.5 (p <0.01), and oxygenation index was reduced, 13.7±8.2 to 12.3±7.2 (p <0.05). Cardiac output and oxygen delivery index (IDO2) were not modified. Demographic data, gas exchange improvement and respiratory system mechanics showed no significant difference between patients with extra-pulmonary and pulmonary ALI/ARDS. There was no evidence of significant adverse events related with this technique. Conclusion: P/V-LF curves information allowed us to adjust ventilatory parameters and optimize gas exchange without detrimental effects on oxygen delivery in mechanically ventilated ALI/ARDS patients
Protective - ventilation strategy in the acute respiratory distress syndrome  [PDF]
Bumba?irevi? Vladimir ?.,Bukumirovi? V.,Popovi? Nada,Nikoli? V.
Acta Chirurgica Iugoslavica , 2004, DOI: 10.2298/aci0403045b
Abstract: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) contribute to progressive hypoxemia in critically ill patients. It has been proved that conventional mechanical ventilation with physiological respiratory volume contributes to further lung damage. In this respect, application of protective ventilatory strategy - pulmonary ventilation with limited volume and pressure can avoid mentioned consequences. The aim of this paper is to discuss mechanims by which elements contained in protective mechanical ventilation of patients with ALI/ARDS prevent further progrssive lung injury, to argue the effects of positive end - expiratory pressure and present insturctions for its application.
The Professional Medical Journal , 2006,
Abstract: Objectives: .To assess the safety, potential efficacy, morbidity andmortality of a small tidal volume mechanical ventilation strategy designed to reduce stretch induced lung injury in ARDS.Design: A prospective interventional experimental Setting: CMH Rawalpindi:..Period: .1st Sept 2001 to 30th June2002. Material & Methods: ARDS is a disease associated with high rate of mortality. It was a prospective interventionalexperimental study of 50 patients who underwent ventilatory support at intensive care unit of a tertiary care teachinghospital Combined Military Hospital Rawalpindi. Results: In both the Traditional Tidal Volume(TTV) and Small TidalVolume (STV) groups 15 of 26 patients [58%] achieved Reversal of Respiratory Failure (RRF). Of the patients whoachieved RRF, the mean number of days on positive pressure ventilation were 11.9±1.9 and 11.3 ± 2.2 days for theTV and STV patients respectively [not significant]. The mean number of days from the first day that weaning from MVwas allowed (when FI 02 was Keywords acute respiratory distress syndrome --- ARDS --- small tidal volume --- STV --- traditional tidal volume --- TTV --- reversal of respiratory failure --- RRF --- multiple organ dysfunction syndrome --- MODS
Role of nitric oxide in management of acute respiratory distress syndrome  [cached]
Akmal A,Hasan Mohd
Annals of Thoracic Medicine , 2008,
Abstract: The current mortality rate of patients suffering from acute respiratory distress syndrome (ARDS) is between 45% and 92%, with most dying within the first two weeks of the illness. In an effort to combat such an alarmingly high mortality rate, various treatment therapies such as low tidal volume ventilation strategies, corticosteroid therapy, and use of nitric oxide (NO) have been attempted in the management of patients with ARDS. Three cases which were admitted to the ICU and confirmed to have ARDS were unable to be weaned from ventilatory support, and nitric oxide therapy was initiated. It improved patients′ oxygenation for short periods of time but did not affect the mortality. The patients could not be weaned from the ventilator and expired.
Corticosteroids in acute respiratory distress syndrome
Fernandes, A.B.S.;Zin, W.A.;Rocco, P.R.M.;
Brazilian Journal of Medical and Biological Research , 2005, DOI: 10.1590/S0100-879X2005000200003
Abstract: improving the course and outcome of patients with acute respiratory distress syndrome presents a challenge. by understanding the immune status of a patient, physicians can consider manipulating proinflammatory systems more rationally. in this context, corticosteroids could be a therapeutic tool in the armamentarium against acute respiratory distress syndrome. corticosteroid therapy has been studied in three situations: prevention in high-risk patients, early treatment with high-dose, short-course therapy, and prolonged therapy in unresolving cases. there are differences between the corticosteroid trials of the past and recent trials: today, treatment starts 2-10 days after disease onset in patients that failed to improve; in the past, the corticosteroid doses employed were 5-140 times higher than those used now. additionally, in the past treatment consisted of administering one to four doses every 6 h (methylprednisolone, 30 mg/kg) versus prolonging treatment as long as necessary in the new trials (2 mg kg-1 day-1 every 6 h). the variable response to corticosteroid treatment could be attributed to the heterogeneous biochemical and molecular mechanisms activated in response to different initial insults. numerous factors need to be taken into account when corticosteroids are used to treat acute respiratory distress syndrome: the specificity of inhibition, the duration and degree of inhibition, and the timing of inhibition. the major continuing problem is when to administer corticosteroids and how to monitor their use. the inflammatory mechanisms are continuous and cyclic, sometimes causing deterioration or improvement of lung function. this article reviews the mechanisms of action of corticosteroids and the results of experimental and clinical studies regarding the use of corticosteroids in acute respiratory distress syndrome.
Acute lung injury and acute respiratory distress syndrome  [cached]
Ragaller Maximillian,Richter Torsten
Journal of Emergencies, Trauma and Shock , 2010,
Abstract: Every year, more information accumulates about the possibility of treating patients with acute lung injury or acute respiratory distress syndrome with specially designed mechanical ventilation strategies. Ventilator modes, positive end-expiratory pressure settings, and recruitment maneuvers play a major role in these strategies. However, what can we take from these experimental and clinical data to the clinical practice? In this article, we discuss substantial options of mechanical ventilation together with some adjunctive therapeutic measures, such as prone positioning and inhalation of nitric oxide.
Acute respiratory distress syndrome: epidemiology and management approaches  [cached]
Walkey AJ,Summer R,Ho V,Alkana P
Clinical Epidemiology , 2012,
Abstract: Allan J Walkey,1 Ross Summer,1 Vu Ho,1 Philip Alkana21The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA; 2Asthma Research Center, Brigham and Women's Hospital, Boston, MA, USAAbstract: Acute lung injury and the more severe acute respiratory distress syndrome represent a spectrum of lung disease characterized by the sudden onset of inflammatory pulmonary edema secondary to myriad local or systemic insults. The present article provides a review of current evidence in the epidemiology and treatment of acute lung injury and acute respiratory distress syndrome, with a focus on significant knowledge gaps that may be addressed through epidemiologic methods.Keywords: acute lung injury, acute respiratory distress syndrome, review, epidemiology
Goal-Oriented Respiratory Management for Critically Ill Patients with Acute Respiratory Distress Syndrome  [PDF]
Carmen Sílvia Valente Barbas,Gustavo Faissol Janot Matos,Marcelo Britto Passos Amato,Carlos Roberto Ribeiro Carvalho
Critical Care Research and Practice , 2012, DOI: 10.1155/2012/952168
Abstract: This paper, based on relevant literature articles and the authors' clinical experience, presents a goal-oriented respiratory management for critically ill patients with acute respiratory distress syndrome (ARDS) that can help improve clinicians' ability to care for these patients. Early recognition of ARDS modified risk factors and avoidance of aggravating factors during hospital stay such as nonprotective mechanical ventilation, multiple blood products transfusions, positive fluid balance, ventilator-associated pneumonia, and gastric aspiration can help decrease its incidence. An early extensive clinical, laboratory, and imaging evaluation of “at risk patients” allows a correct diagnosis of ARDS, assessment of comorbidities, and calculation of prognostic indices, so that a careful treatment can be planned. Rapid administration of antibiotics and resuscitative measures in case of sepsis and septic shock associated with protective ventilatory strategies and early short-term paralysis associated with differential ventilatory techniques (recruitment maneuvers with adequate positive end-expiratory pressure titration, prone position, and new extracorporeal membrane oxygenation techniques) in severe ARDS can help improve its prognosis. Revaluation of ARDS patients on the third day of evolution (Sequential Organ Failure Assessment (SOFA), biomarkers and response to infection therapy) allows changes in the initial treatment plans and can help decrease ARDS mortality. 1. Introduction Acute respiratory distress syndrome (ARDS) is due to an increase in the pulmonary alveolar-capillary membrane permeability causing lung edema rich in protein and consequently acute hypoxemic respiratory failure in genetically susceptible patients exposed to determined risk factors [1–14]. A recent study showed that the del/del genotype (patients homozygous for the 4 base pair deletion in the promoter of NFKB1) is associated with an age-dependent increase in odds of developing ARDS (OR 5.21, 95% CI 1.35–20.0) and patients with the del/del genotype and ARDS also have increased hazard of 60-day mortality (HR 1.54, 95% CI 1.01–2.36) and more organ failure ( ?? < 0 . 0 0 1 ) [15]. All age groups may be affected, although the syndrome has a higher incidence and mortality in older people [16]. The most common precipitating causes of ARDS are pulmonary infections, nonpulmonary sepsis, shock, gastric aspiration, thoracic trauma, fat embolism, near drowning, inhalational injury, cardiopulmonary bypass, drug overdose, acute pancreatitis, and high-risk trauma (especially traumatic brain injury)
Bubble–CPAP vs. Ventilatory–CPAP in Preterm Infants with Respiratory Distress
Bahareh Bahman-Bijari,Arash Malekiyan,Pedram Niknafs,Mohammad-Reza Baneshi
Iranian Journal of Pediatrics , 2011,
Abstract: Objective:Application of Continuous Positive Airway Pressure (CPAP) in neonate with respiratory distress is associated with reduction of respiratory failure, reduced complications and mortality. Bubble CPAP (B-CPAP) and ventilator-derived CPAP (V-CPAP) are two most popular CPAP modes. We aimed to determine whether B-CPAP and V-CPAP would have different survival rate and possible complications. Methods: This prospective clinical trial was performed on 50 preterm neonates weighing 1000-2000 gr who were admitted to the neonatal intensive care unit of Afzalipoor Hospital because of respiratory distress between June 2009 and May 2010. Patients were randomly allocated into treatment groups using minimization technique. Survival analysis was applied to estimate and compare survival rates. Duration of oxygen therapy, hospital stay as well as hospitalization costs were compared using independent sample t-test. Findings:Estimated survival rates at 24 hours in B-CPAP and V-CPAP groups were 100% and 77% respectively. Corresponding figures at 48 hours were 100% and 71%. In addition the hospitalization cost in V-CPAP group was significantly higher than in B-CPAP group. Conclusion: According to our results, B-CPAP was effective in the treatment of neonates who were suffering from respiratory distress and reduced the duration of hospital stay. In addition to mentioned benefits, its low cost may be the reason to use B-CPAP broadly compared with V-CPAP.
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