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  • ARDS
  • 1 2 Despite vigorous researches on pharmacological treatment and ventilator strategy in recent decades, ARDS with profound hypoxaemia continues to be associated with high mortality rate. (hkmj.org)
  • 1. What 's New in CriticalCare of the Burn - InjuredPatient?Tina L. Palmieri, MD, FACS, FCCMa,b,* KEYWORDS Burns Sepsis Inhalation injury Critical care Glycemic controlMortality after burn injury has decreased markedly (ARDS).4 The risk for mortality from ALI and ARDSin the past 30 years. (slideshare.net)
  • Amato MBP, Barbas CSV, Medeiros DM, et al (1995) Beneficial effects of the "open lung approach" with low distending pressures in ARDS: A prospective randomized study on mechanical ventilation. (springer.com)
  • Acute respiratory distress syndrome (ARDS) is a medical condition occurring in critically ill patients characterized by widespread inflammation in the lungs. (wikipedia.org)
  • The hallmark of ARDS is diffuse injury to cells which form the barrier of the microscopic air sacs of the lungs, surfactant dysfunction, activation of the innate immune system response, and dysfunction of the body's regulation of clotting and bleeding. (wikipedia.org)
  • In effect, ARDS impairs the lungs' ability to exchange oxygen and carbon dioxide with the blood across a thin layer of the lungs' microscopic air sacs known as alveoli. (wikipedia.org)
  • ARDS may be seen in the setting of severe pulmonary (pneumonia) or systemic infection (sepsis), following trauma, multiple blood transfusions (TRALI), severe burns, severe inflammation of the pancreas (pancreatitis), near-drowning or other aspiration events, drug reactions, or inhalation injuries. (wikipedia.org)
  • In addition to generally broadening the diagnostic thresholds, other notable changes from the prior 1994 consensus criteria include discouraging the term "acute lung injury," and defining grades of ARDS severity according to degree of decrease in the oxygen content of the blood. (wikipedia.org)
  • Generally, radiographic findings of fluid accumulation (pulmonary edema) affecting both lungs and unrelated to increased cardiopulmonary vascular pressure (such as in heart failure) may be suggestive of ARDS. (wikipedia.org)
  • Ultrasound findings suggestive of ARDS include the following: Anterior subpleural consolidations Absence or reduction of lung sliding "Spared areas" of normal parenchyma Pleural line abnormalities (irregular thickened fragmented pleural line) Nonhomogeneous distribution of B-lines (a characteristic ultrasound finding suggestive of fluid accumulation in the lungs) ARDS is a form of fluid accumulation in the lungs not explained by heart failure (noncardiogenic pulmonary edema). (wikipedia.org)
  • Additional common findings in ARDS include partial collapse of the lungs (atelectasis) and low levels of oxygen in the blood (hypoxemia). (wikipedia.org)
  • It is well-known that mechanical ventilation in itself can harm the lung, inducing or aggravating ARDS. (biomedcentral.com)
  • It is clinically indistinguishable from acute lung injury or acute respiratory distress syndrome (ALI/ARDS). (wikipedia.org)
  • One of the primary complications that presents in patients mechanically ventilated is acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). (wikipedia.org)
  • adult respirat
  • Pelosi P, D'Andrea L, Vitale G, Pesenti A, Gattinoni L (1994) Vertical gradient of regional lung inflation in adult respiratory distress syndrome. (springer.com)
  • Gattinoni L, Pelosi P, Crotti S, Valenza F (1995) Effects of positive end-expiratory pressure on regional distribution of tidal volume and recruitment in adult respiratory distress syndrome. (springer.com)
  • Hickling KG, Walsh J, Henderson S, Jackson R (1994) Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: a prospective study. (springer.com)
  • Mclntyre RC, Haenel JV, Moore FA, Read RR, Burch JM, Moore EE (1994) Cardiopulmonary effects of permissive hypercapnia in the management of adult respiratory distress syndrome. (springer.com)
  • Gattinoni L, Bombino M, Pelosi P, et al (1994) Lung structure and function in different stages of severe adult respiratory distress syndrome. (springer.com)
  • Bachofen M, Weibel ER (1982) Structural alternations of lung parenchyma in the adult respiratory distress syndrome. (springer.com)
  • pressures
  • Dreyfuss D, Basset G, Soler P, Saumon G (1985) Intermittent positive-pressure hyperventilation with high inflation pressures produces pulmonary microvascular injury in rats. (springer.com)
  • In the lungs, reopening of atelectatic tissue mimics avalanches, with different regions opening at distinct pressures and times. (asahq.org)
  • 4 In PROVHILO study, 2 the recruitment maneuver was based on a stepwise increase of tidal volumes at a positive end-expiratory pressure (PEEP) of 12 cm H 2 O. The time spent at different inspiratory pressures, including levels above 30 cm H 2 O, was approximately 15 s at each pressure. (asahq.org)
  • This barotrauma was caused by the high peak inspiratory pressures (PIP) required to oxygenate stiff lungs. (docplayer.net)
  • pneumonia
  • Survival after burn injury to approaches 40% to 50%.5 This mortality may bemore than 90% of the total body surface area is directly due to respiratory failure and hypoxia, orcommon in children, with some authors maintain- it may result from associated multisystem organing that virtually all children with burn injury should failure or ventilator-associated pneumonia. (slideshare.net)
  • These authors reported a syndrome characterized by acute onset of tachypnea, hypoxemia, and loss of lung compliance after a variety of stimuli, such as pneumonia and multiple trauma. (springer.com)
  • oxygenation
  • Atelectasis was induced by bronchial blocking: after five minutes of stabilization and pre-oxygenation with F I O 2 = 1.0, a silicon cylinder blocker was wedged in the terminal bronchial tree. (biomedcentral.com)
  • An alternative treatment, extracorporeal membrane oxygenation, uses cardio-pulmonary bypass technology to temporarily provide gas exchange, allowing ventilator settings to be reduced. (biomedcentral.com)
  • regional lung
  • Over-distension injury results from increased regional lung volume and excessive deformation of epithelial and endothelial cells, as well as of the extracellular matrix, leading to a pro-inflammatory response. (biomedcentral.com)
  • The authors' hypothesis was that after a regional lung injury, the noxious effect of mechanical ventilation on the remaining aerated parenchyma would be more pronounced. (asahq.org)
  • volume
  • Jonson B, Richard JC, Straus C, Mancebo J, Lemaire F, Brochard L (1999) Pressure-volume curves and compliance in acute lung injury: evidence of recruitment above the lower inflection point. (springer.com)
  • Low tidal volume (LVT) has proved to be an effective ventilation strategy. (biomedcentral.com)
  • Mead J, Collier C (1959) Relationship of volume history of lungs to respiratory mechanics in anesthetised dogs. (springer.com)
  • In addition, the comparative increase in compliance was 33% on average, which in noninjured lungs ventilated with low tidal volume is more than modest and hardly explained by redistribution of ventilation without opening of atelectatic areas. (asahq.org)
  • After tracheal intubation, the lungs of each animal were ventilated with a tidal volume of 18 ml/kg using a volume-cycled ventilator (model 607, Harvard Apparatus, Natick, MA). (asahq.org)
  • Although total liquid ventilation (TLV) with completely liquid-filled lungs can be beneficial, the complex liquid-filled tube system required is a disadvantage compared to gas ventilation-the system must incorporate a membrane oxygenator, heater, and pumps to deliver to, and remove from the lungs tidal volume aliquots of conditioned perfluorocarbon (PFC). (wikipedia.org)
  • One research group led by Thomas H. Shaffer has maintained that with the use of microprocessors and new technology, it is possible to maintain better control of respiratory variables such as liquid functional residual capacity and tidal volume during TLV than with gas ventilation. (wikipedia.org)
  • In contrast, partial liquid ventilation (PLV) is a technique in which a PFC is instilled into the lung to a volume approximating functional residual capacity (approximately 40% of total lung capacity). (wikipedia.org)
  • atelectasis
  • Atelectasis was successfully induced in the basal region of the lung of 26 out of 29 animals. (biomedcentral.com)
  • We decisively disagree that the occurrence of postoperative atelectasis in PROVHILO study 2 indicates inappropriate intraoperative lung recruitment. (asahq.org)
  • 2001
  • Glaister DH (2001) Effects of aceleration on the lung. (springer.com)
  • Tsubo T, Sakai I, Suzuki A, Okawa H, Ishihara H, Matsuki A (2001) Density detection in dependent left lung region using transesophageal echocardiography. (springer.com)
  • 1983
  • Menitove SM, Goldring RM (1983) Combined ventilator and bicarbonate strategy in the management of status asthmaticus. (springer.com)
  • experimental
  • Dreyfuss D, Saumon G (1998) Ventilator-induced lung injury: lessons from experimental studies. (springer.com)
  • An experimental study on lung morphology and gas exchange. (springer.com)
  • Preischemic hyperglycemia can exacerbate the extent of neurologic injury and potentiate regional lactic acidosis in brain tissue, [ 9-11 ] as has been shown with glucose loading in experimental animals before circulatory arrest during CPB. (asahq.org)
  • fluid
  • Bronchoalveolar lavage fluid (BALF) was collected and lungs were harvested for analysis. (biomedcentral.com)
  • Lung edema, histological lung injury index, concentrations of total protein, total cell counts, number of neutrophils in bronchoalveolar lavage fluid (BALF), tumor necrosis factor-α, interleukin (IL)-1β, IL-6, IL-10 and transforming growth factor-β1 in BALF were significantly increased in HVT rats. (biomedcentral.com)
  • Partial liquid ventilation (PLV) involves filling the lungs with a fluid. (wikipedia.org)
  • physiologic
  • It is also indicated as prophylaxis for imminent collapse of other physiologic functions, or ineffective gas exchange in the lungs. (wikipedia.org)
  • spontaneous
  • Although similar in modality, these terms describe how a mode is intended to inflate the lung, rather than defining the characteristics of synchronization or the way spontaneous breathing efforts are supported. (wikipedia.org)
  • ARDS
  • Trials of surfactant in adults with ALI and ARDS have not demonstrated a mortality benefit [ 6 - 9 ], perhaps due to inherent differences in the aetiology of lung injury in adults, the design features of the trials, the mode and timing of surfactant administration or the type and dose of surfactant used. (biomedcentral.com)
  • In fact, Pesenti and coworkers [ 10 ] found no reduction in end-expiratory lung volume (EELV) or arterial oxygen saturation in patients with ALI and ARDS after suctioning with such a system. (biomedcentral.com)
  • It was not until 1994 that The American -European Consensus Conference on ARDS set the criteria used today to define both ALI and ARDS in research and clinical medicine. (bjmp.org)
  • There are no gold standard radiological, laboratory or pathological tests to diagnosis ALI and ARDS and patients are given the diagnosis based on meeting the criteria agreed in 1994. (bjmp.org)
  • It is clinically indistinguishable from acute lung injury or acute respiratory distress syndrome (ALI/ARDS). (wikipedia.org)
  • One of the primary complications that presents in patients mechanically ventilated is acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). (wikipedia.org)
  • Acute respiratory distress syndrome (ARDS) is a medical condition occurring in critically ill patients characterized by widespread inflammation in the lungs. (wikipedia.org)
  • The hallmark of ARDS is diffuse injury to cells which form the barrier of the microscopic air sacs of the lungs, surfactant dysfunction, activation of the innate immune system response, and dysfunction of the body's regulation of clotting and bleeding. (wikipedia.org)
  • In effect, ARDS impairs the lungs' ability to exchange oxygen and carbon dioxide with the blood across a thin layer of the lungs' microscopic air sacs known as alveoli. (wikipedia.org)
  • ARDS may be seen in the setting of severe pulmonary (pneumonia) or systemic infection (sepsis), following trauma, multiple blood transfusions (TRALI), severe burns, severe inflammation of the pancreas (pancreatitis), near-drowning or other aspiration events, drug reactions, or inhalation injuries. (wikipedia.org)
  • In addition to generally broadening the diagnostic thresholds, other notable changes from the prior 1994 consensus criteria include discouraging the term "acute lung injury," and defining grades of ARDS severity according to degree of decrease in the oxygen content of the blood. (wikipedia.org)
  • Generally, radiographic findings of fluid accumulation (pulmonary edema) affecting both lungs and unrelated to increased cardiopulmonary vascular pressure (such as in heart failure) may be suggestive of ARDS. (wikipedia.org)
  • Ultrasound findings suggestive of ARDS include the following: Anterior subpleural consolidations Absence or reduction of lung sliding "Spared areas" of normal parenchyma Pleural line abnormalities (irregular thickened fragmented pleural line) Nonhomogeneous distribution of B-lines (a characteristic ultrasound finding suggestive of fluid accumulation in the lungs) ARDS is a form of fluid accumulation in the lungs not explained by heart failure (noncardiogenic pulmonary edema). (wikipedia.org)
  • Additional common findings in ARDS include partial collapse of the lungs (atelectasis) and low levels of oxygen in the blood (hypoxemia). (wikipedia.org)
  • Alveolar Fluid Clearance
  • At that time, alveolar fluid clearance was measured by an increase in protein concentration over 1 h of a 5% albumin solution instilled into the lungs. (physiology.org)
  • 1 ) whether baseline and β-adrenoceptor agonist-stimulated alveolar fluid clearance rates were altered during heart failure and 2 ) the impact of heart failure on alveolar epithelial type II cell hyperplasia and changes in lung epithelial cell Na and Cl channel mRNA and protein expression. (physiology.org)
  • ventilatory
  • As a result, patients either had to conform to the ventilator output as set by the clinician or be sedated and frequently paralyzed in order to tolerate ventilatory support. (rcjournal.com)
  • The use of a lung-protective ventilatory strategy produced the first major breakthrough in supportive care for patients with ALI, reducing mortality from 40 to 31% ( 4 ). (pubmedcentralcanada.ca)
  • To prevent outrageous ventilatory parameters, pause pressures in the conventional group were limited to 50 cmH 2 O. In the study group, pressures were limited to 30 cmH 2 O. In addition, in no patient was the tidal volume permitted to drop under 4 ml/kg. (anaesthetist.com)
  • Management centres around supportive care and treating the cause, but evidence supports use of low tidal volume ventilatory settings and conservative intravenous fluid strategies. (bjmp.org)
  • rats
  • Lung edema, histological lung injury index, concentrations of total protein, total cell counts, number of neutrophils in bronchoalveolar lavage fluid (BALF), tumor necrosis factor-α, interleukin (IL)-1β, IL-6, IL-10 and transforming growth factor-β1 in BALF were significantly increased in HVT rats. (biomedcentral.com)
  • Lung morphology showed significant alveolar epithelial type II cell hyperplasia in heart failure rats. (physiology.org)
  • These aims were designed to test the general hypothesis that the ability to absorb air space fluid is altered by alveolar epithelial type II cell hyperplasia and/or alterations in the ion transport machinery responsible for edema fluid reabsorption in lungs of rats suffering from heart failure. (physiology.org)
  • airway injury
  • Endotracheal intubation is a traumatic and painful procedure that requires sedation and can be associated with hemodynamic instabilities, airway emergencies, acute airway injury, colonization of the trachea, reduced ciliary movement, secretions, high resistance to air flow, and increased WOB. (rcjournal.com)
  • volume
  • Interestingly, tidal volume variability in the physiological resting awake state is generally higher than in other physiological states, as for example during non‐rapid eye movement sleep [ 5 ] and in the diseased state. (biomedcentral.com)
  • In patients with restrictive lung disease [ 6 ] and in patients with COPD [ 12 ], the variability in the tidal volume pattern is reduced to 22 ± 5 and 25.3 ± 16.3 %, respectively. (biomedcentral.com)
  • The poor tolerance of PFD was likely related to a large amount of residual PFC, as observed using MRI in all lung samples (≈10% of lung volume). (biomedcentral.com)
  • At the time that IMV was introduced into adult mechanical ventilation, the only ventilators available for use in the ICU were intermittent positive-pressure breathing type pressure targeted ventilators and ventilators with volume control designed to only provide controlled mechanical ventilation. (rcjournal.com)
  • Over time, manufacturers incorporated IMV into adult ventilators with volume control mode in the form of synchronized IMV (SIMV). (rcjournal.com)
  • Compared with Gas -filled lungs, both PF5080 -groups had a significantly higher total lung volume, but no other differences. (biomedcentral.com)
  • 13 The ETT bypasses the glottis and hinders the neonate's adaptive mechanism (grunting 14 ) for preserving the end-expiratory lung volume. (rcjournal.com)
  • Lung recruitment (LR) manoeuvres may be effective in rapidly regaining lung volume and improving oxygenation after ETS. (biomedcentral.com)
  • Before (baseline) and over 25 min following each ETS procedure, partial arterial oxygen tension (PaO 2 ) and end-expiratory lung volume were measured. (biomedcentral.com)
  • With LR manoeuvre end-expiratory lung volume was unchanged after ETS, whereas without LR manoeuvre end-expiratory lung volume was still reduced (approximately 10%) at 5 and 15 min after ETS ( P = 0.01). (biomedcentral.com)
  • A LR manoeuvre immediately following ETS was, as an adjunct to positive end-expiratory pressure, effective in rapidly counteracting the deterioration in PaO 2 and lung volume caused by open ETS in ventilator-treated patients with acute lung injury or acute respiratory distress syndrome. (biomedcentral.com)
  • It has recently been suggested that a closed suction system may be effective in preventing suctioning-induced decreases in lung volume and oxygenation. (biomedcentral.com)
  • Brochard and coworkers [ 13 ] showed that lung volume and arterial oxygenation could be maintained during open suctioning by using constant flow insufflation. (biomedcentral.com)
  • Hence, the mean systemic filling pressure obtained via extrapolation of pressure-flow relationships with airway occlusion overestimates the mean systemic filling pressure measured during right atrial balloon occlusion at end-expiratory lung volume. (physiology.org)
  • One research group led by Thomas H. Shaffer has maintained that with the use of microprocessors and new technology, it is possible to maintain better control of respiratory variables such as liquid functional residual capacity and tidal volume during TLV than with gas ventilation. (wikipedia.org)
  • In contrast, partial liquid ventilation (PLV) is a technique in which a PFC is instilled into the lung to a volume approximating functional residual capacity (approximately 40% of total lung capacity). (wikipedia.org)
  • In order to correctly and effectively conduct PLV, it is essential to properly dose a patient to a specific lung volume (10-15 ml/kg) to recruit alveolar volume redose the lung with PFC liquid (1-2 ml/kg/h) to oppose PFC evaporation from the lung. (wikipedia.org)
  • edema
  • Bumetanide attenuated the activation of p-NKCC1 and lung edema after IR. (frontiersin.org)
  • The process leads to increased microvascular permeability, the influx of protein-rich fluid, and the formation of lung edema ( 2 - 4 ). (frontiersin.org)
  • capillaries
  • These results demonstrate that the initial colon cancer cell adhesion in the capillaries of the lung is predominantly mediated by tumor cell - endothelial cell interactions, possibly supported by platelets. (biomedcentral.com)
  • rapidly
  • PFOC was rapidly cleared from the lungs and virtually disappeared after 4 days whereas PFOB persisted at significant levels and led to foam macrophage infiltration. (biomedcentral.com)
  • pulmonary
  • Lungs of heart failure patients undergo extensive remodeling ( 18 , 25 , 26 ), resulting in architectural changes such as pulmonary artery and vein wall thickening, pulmonary arteriole muscularization, and capillary endothelial and alveolar epithelial basement membrane thickening ( 18 ). (physiology.org)
  • Although plasma protein C levels increased and pulmonary dead space fraction decreased, there was no benefit with regard to ventilator-free days (primary study endpoint), mortality, or lung injury score. (pubmedcentralcanada.ca)
  • severe
  • Acute lung injury is a syndrome with a diagnostic criteria base on hypoxaemia and a classical radiological appearance, with acute respiratory distress syndrome at the severe end of the disease spectrum. (bjmp.org)
  • When this becomes severe to the point of stupor or coma (defined as a score on the Glasgow Coma Scale of less than 8), dynamic collapse of the extrinsic muscles of the airway can obstruct the airway, impeding the free flow of air into the lungs. (wikipedia.org)
  • PEEP
  • This landmark paper described a group of 12 patients with "Respiratory Distress Syndrome" who had refractory hypoxaemia, decreased lung compliance, diffuse infiltrates on chest radiography and required positive end expiratory pressure (PEEP) for ventilation. (bjmp.org)
  • in 1988 using a 4 point lung injury scoring system including the level of PEEP used in ventilation, ratio of arterial oxygen tension to fraction of inspired oxygen (PaO₂/FiO₂), static lung compliance and chest radiography changes 2 . (bjmp.org)
  • collapse
  • It is also indicated as prophylaxis for imminent collapse of other physiologic functions, or ineffective gas exchange in the lungs. (wikipedia.org)
  • alveoli
  • The hope is that the liquid will help the transport of oxygen to parts of the lung that are flooded and filled with debris, help remove this debris and open up more alveoli improving lung function. (wikipedia.org)
  • concentrations
  • They were ultimately euthanized for histological analyses and assessment of PFC residual concentrations within the lungs using dual nuclei fluorine and hydrogen Magnetic Resonance Imaging (MRI). (biomedcentral.com)
  • impair
  • Subsequently, HT-29LMM cells were treated with function blocking antibodies against β1-, β4-, and αv-integrins wich also did not impair tumor cell adhesion in the lung. (biomedcentral.com)
  • healthy
  • The basic rationale for variable controlled mechanical ventilation is that the use of a physiological variability in the respiratory pattern, as observed in the healthy resting state, may be beneficial to improve function and reduce damage in the diseased lung. (biomedcentral.com)
  • For control, 10 healthy animals with gas ( Healthy-Gas , n = 5) or PF5080 filled lungs ( Healthy-PF5080 , n = 5) were studied. (biomedcentral.com)