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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Classical symptoms and signs common to most pulmonary diseases, such as dyspnea, cough, chest pain and cyanosis, are reviewed to assess their significance for diagnosis and evaluation of the degree of impairment in acute respiratory failure. While frequently useful for diagnosis, they are often inadequate to determine the degree of emergency. In each particular etiology other information is needed to obtain an objective and quantitative assessment. Two examples selected for their frequency are considered: barbiturate intoxication and severe exacerbations of asthma. The severity of barbiturate poisoning can be assessed clinically in the light of the degree of central nervous depression. Classical signs and wheezing are poorly correlated with the intensity of acute asthmatic attacks, but high-risk patients can be identified by seeking neglected physical findings such as pulsus paradoxus and sternomastoid muscle contraction. In many other pulmonary emergencies further studies are required to assess the usefulness of various clinical signs as objective indices of the severity of respiratory impairment.
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PMID:[Various aspects of respiratory emergencies in non-hospital practice]. 53 46

The cardiac response to volume loading was evaluated in fifty severely septic patients. After a rapid infusion of albumin or whole blood the cardiac index (CI) and left ventricular stroke work index (LVSWI) were recorded as the pulmonary arterial wedge pressure (PAWP) increased. Initial values of PAWP, CI, and LVSWI were similar in both the nineteen surviving and thirty-one nonsurviving patients. Surviving patients, however, demonstrated greater increases in CI and LVSWI as PAWP rose. Nearly half of both patient groups developed decreases in CI and LVSWI as the PAWP continued to increase. These downslopes occurred at relatively low PAWP and are taken as evidence of an abnormality of myocardial function in both survivors and nonsurvivors. The lower upslope of the performance curves in nonsurvivors indicates myocardial depression or a negative inotropic effect. Cardiac ischemia, acute respiratory failure, and high affinity red cells were found to diminish the cardiac response to volume loading, whereas hepatic and renal failure were associated with a good CI and LVSWI response.
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PMID:Myocardial depression during sepsis. 84 86

1. Hypoxic and hypercapnic ventilatory drives were measured in eight healthy male subjects before and after ingestion of ethanol, in a dose of 17 mmol/kg body weight. 2. A significant decrease in hypoxic ventilatory drive was observed at 20 min after ethanol (P less than 0.05). A significant depression in hypercapnic drive was observed at 70 min after indigestion of ethanol (P less than 0.05). The mean peak blood ethanol (24mmol/1) occurred at 20 min, at which time the lowest mean hypoxic drive was recorded. 3. Ethanol in moderate doses produced a depression of both hypoxic and hypercapnic ventilatory drives in normal subjects. This suggests that ethanol may play a role in the precipitation of acute respiratory failure in certain patients in whom the ventilatory drive is already impaired, as in chronic airways obstruction.
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PMID:Effect of ethanol on the ventilatory responses to oxygen and carbon dioxide in man. 114 93

Intermittent Mandatory Pressure Release Ventilation (IMPRV) is a positive pressure spontaneous breathing ventilatory mode in which airway pressure is released intermittently and synchronously with patient's spontaneous expiration in order to provide ventilatory assistance. Eight critically ill patients free of any factor known to alter chest wall mechanics (group 1) and 8 critically ill patients whose spontaneous respiratory activity was markedly altered by a flail chest, or by a C5 quadraplegia and/or by the administration of opioids (group 2) were studied prospectively. CPAP and IMPRV were administered to each patient in a random order during a 1 h period using a CESAR ventilator. Gas flow, tidal volume, tracheal pressure, esophageal pressure, end-expiratory lung volume and hemodynamic parameters were measured. In group 1 patients, the ventilatory assistance provided by IMPRV was associated with a significant decrease in spontaneous tidal volume whereas all other respiratory parameters remained unchanged. In group 2 patients, IMPRV increased minute ventilation from 8.0 +/- 2.61/min to 12.2 +/- 1.81/min (p less than 0.05), decreased PaCO2 from 46 +/- 7.3 mmHg to 38 +/- 6.8 mmHg (p less than 0.05) and reduced respiratory frequency from 21 +/- 10 bpm to 14 +/- 5.7 bpm (p less than 0.07). These results show that IMPRV provides significant ventilatory assistance to patients with mild acute respiratory failure either by decreasing patient's contribution to minute ventilation or by increasing alveolar ventilation in presence of respiratory depression of central or peripheral origin.
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PMID:Continuous positive airway pressure (CPAP) vs. intermittent mandatory pressure release ventilation (IMPRV) in patients with acute respiratory failure. 161 99

Changes in organ blood flow (Q) produced by 20 cm H2O positive end-expiratory pressure (PEEP) were measured before and after the induction of hyperdynamic sepsis in nine unanesthetized sheep. During the baseline nonseptic study, PEEP was associated with a 9% fall in thermodilution-measured systemic Q, although arterial perfusing pressures were unaffected. Concurrently, microsphere-derived Q was maintained to the brain and heart, but fell to liver, spleen, pancreas, kidney, large intestine, and gastrocnemius. Twenty-four to 36 h after cecal ligation and perforation, a pre-PEEP septic study demonstrated an increase in all of the cardiac index (CI) (+43%) and systemic O2 delivery (+54%) when compared with the nonseptic study, whereas whole-body O2 extraction (-30%) was depressed. Although PEEP depressed systemic Q (-17%) during the septic study to a greater extent than during the nonseptic study (p less than 0.02), absolute organ Q fell only to pancreas, liver, and spleen. Relative to the simultaneous fall in the CI, Q to some splanchnic organs was not depressed by PEEP to the same magnitude in the septic as in the nonseptic study. When an infusion of Ringer's lactate (993 +/- 295 ml) subsequently restored systemic Q to pre-PEEP septic levels, individual flows that had been depressed by PEEP were not restored. Furthermore, Q-kidney continued to fall, such that the postfluid Q-kidney (-19%) was significantly less than was demonstrated in the pre-PEEP septic study. We postulate that differences noted in the distribution of organ Q between the nonseptic and hyperdynamic septic studies after the application of PEEP were secondary to the vasculopathy of sepsis and/or an alteration in the function of specific organ microcirculations. However, these data do not address whether the changes in organ Q distribution after a PEEP-mediated depression in systemic Q during sepsis significantly restricted tissue DO2. The inability to acutely reverse the PEEP-mediated changes in organ Q after restoring systemic Q by a fluid infusion also suggests the need to evaluate alternative methods of support to organ Q in acute respiratory failure secondary to sepsis when the addition of PEEP acutely depresses systemic DO2.
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PMID:Hyperdynamic sepsis modifies a PEEP-mediated redistribution in organ blood flows. 218 82

Vascular reactivity in-vivo and in-vitro was examined in rats with acute renal failure produced by bilateral nephrectomy or intramuscular glycerol injection. Bilaterally nephrectomized rats displayed enhanced pressor responses to noradrenaline and angiotensin. However, the contractile responses to noradrenaline, angiotensin and potassium chloride of aortic rings and portal vein segments from nephrectomized rats were not significantly different from the responses obtained in vessels from sham-operated controls. Rats with glycerol-induced ARF which were pretreated with indomethacin had significantly lower pressor responses to noradrenaline and angiotensin than similarly treated control animals. Aortic rings from glycerol-injected rats produced significantly smaller contractions to noradrenaline than preparations from controls. This difference was not abolished by incubation of vessels with indomethacin. The findings suggest that the absence of kidneys or the presence of damaged renal tissue and not uraemia itself have pronounced but opposite effects on vascular reactivity. The depression of vascular reactivity in glycerol-induced ARF does not appear to be a result of increased production of prostaglandins.
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PMID:Vascular reactivity in experimental acute renal failure. 286 52

A new method of diaphragmatic pacing by transcutaneous electrical stimulation, using alternative currents with frequency and amplitude modulations, was tested in 12 subjects: 3 were normal and awake (group I); 4 were studied in acute respiratory failure while under mechanical ventilation and central apnea (group II) and 5 were studied while anaesthetized for peripheral venous surgery and breathing spontaneously (group III). Stimulation was performed either during spontaneous ventilation (groups I and II) or during short periods of respiratory depression (group III). Tidal volume was measured by pneumotachography. A positive correlation was found between stimulus intensity and inspired volume. This effect was not due to voluntary control alone, since diaphragmatic stimulation could support 24% of the theoretical minute ventilation in group II subjects and 64% in group III subjects. These preliminary results demonstrate the relative efficacy of this new method of diaphragmatic pacing using computerized alternative currents.
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PMID:[Trial of a new technic of transcutaneous diaphragmatic electrostimulation in man]. 293 90

Acute respiratory failure after hepatic resection, especially in case of concomitant liver dysfunction, is the most troublesome postoperative complication. In order to clarify the pathophysiological mechanism of acute respiratory failure, EVLW (extravascular lung water) was measured by double indicator dilution method in canine model. Mongrel dogs underwent laparotomy and the common bile duct was ligated and divided. After 6 weeks, EVLW was significantly elevated compared with that of normal dogs (p less than 0.05). From 4 hours after 70% hepatic resection dextran-40 was loaded to increase PWP (pulmonary wedge pressure). EVLW was increased accompanying the elevation of PWP in all groups, but in the group with biliary obstruction EVLW was significantly increased for the same elevation of PWP. These results suggest that permeability of pulmonary capillary was highly increased after hepatic resection in biliary obstruction group. Pulmonary edema in this canine model seems to resemble ARDS in human and the pathophysiological mechanism was thought to be related with depression of RES phagocytic function, activation of complement system and pulmonary vascular plugging by aggregates of degenerating granulocytes and endothelial injury. Gabexate mesilate blocked the increase of the lung vascular permeability and was thought to be effective to protect the lung from postoperative acute respiratory failure.
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PMID:[Acute respiratory failure after hepatic resection in canine biliary obstruction model]. 314 48

An uncommon but treatable etiology of acute respiratory failure is hypokalemia. A 36-year-old woman with previously undiagnosed distal renal tubular acidosis presented with foot and ankle swelling that was being treated with furosemide. She had been seen by three physicians within 24 hours and was diagnosed as having depression or hysterical conversion reaction. Her symptoms progressed to respiratory arrest. Initial treatment consisted of administering 40 mEq of KCl over one hour through a central venous line. The patient recovered rapidly and was weaned off a respirator within 24 hours of admission.
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PMID:Acute respiratory arrest due to hypokalemia. 334 25

A male patient was admitted to the hospital in coma and acute respiratory failure following the oral intake of benzodiazepines and alcohol. On the fourth day after admission, the patient was conscious, results of clinical examination of the respiratory system were normal, and pulmonary ventilation tests and blood gas measurements were within normal limits. However, mouth occlusion pressure and ventilatory response to CO2 were found to be markedly reduced. In the period of weaning the discrepancy between the normal clinical picture and blood gases and the laboratory findings of respiratory depression implies that there is a slowing in recovery of the respiratory center in this type of intoxication.
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PMID:Prolonged respiratory center depression after alcohol and benzodiazepines. 396 34


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