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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Conventional PEEP ventilation has been recently reported to be deleterious in some cases of ARF with unilateral pneumonia. In such respect, two cases of unilateral bacterial pneumonia were intubated with a Carlens tracheal tube. Measurement of tidal volume, static compliance, and functional residual capacity of each lung showed marked inequality. Subsequently, both patients were ventilated with a selective distribution circuit, allowing the introduction of a PEEP valve in the expiratory line of the diseased lung. Evident improvement in blood gases was obtained within 24 hours, as tidal volume, static compliance, and FRC of the diseased lung were markedly improved. In one case equalisation of V/Q ratio was documented using the 81m Kr method. Final recovery was obtained in one case.
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PMID:Differential ventilation in unilateral lung disease: effects on respiratory mechanics and gas exchange. 39 50

Thirty-six renal transplant recipients with 47 episodes of septicemia were studied carefully at the bedside, in the laboratory, and, all too frequently, at autopsy. Gram-negative bacilli were the pathogens most commonly responsible, folloed in order of frequency by gram-positive cocci, polymicrobic etiologic agents, Listeria monocytogenes, and fungi. Infections of the transplant site (urinary tract or transplant wounds) caused septicemia in 51% of the cases. Other portals of entry included the lung, the abdomen, the meninges, the endocardium, and miscellaneous sites. The outcome of septicemia was fatal in 36% of the episodes. There was a significantly higher mortality for episodes of septicemia associated with pneumonia, persistent bloodstream infection, leukopenia, metastatic abscesses, clinical shock, and acute respiratory failure. The high mortality of septicemia in renal allograft recipients demands that extremely careful attention be given to subtle clinical clues denoting the onset and predicting the course of the disorder.
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PMID:Septicemia in renal transplant recipients. 79 Jul 36

The PAO2-PaO2 relationship was studied for the entire therapeutic range of oxygen in patients and animals in acute respiratory failure. The method is based on the assumption that the steady state values of PaO2 may be obtained as a mean of the two PaO2 values at an identical F1O2, one obtained 6 min after the F1O2 was raised from a lower level, the other obtained 6 min after the F1O2 was reduced from the higher level. We found that the shunts were large in the low F1O2 range (170 mmHg and below), took a minimum value in the moderate PAO2 range (170 to 300 mmHg), and increased again in the high PAO2 range (300 to 700 mmHg). A similar pattern was observed in the animal experiments, two or more hr following experimentally produced produced aspiration pneumonitis. In contrast, the dogs with bilateral pneumothorax showed a pattern which followed the isoshunt line closely. It was concluded that patients with acute respiratory failure requiring artificial ventilation have two componenents of the pulmonary shunt, one parallel with and the other inversely related with the PAO2. Possible mechanisms for the former were discussed.
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PMID:PAO2-PaO2 relationship for the entire therapeutic range of oxygen in acute respiratory failure. 91 65

A marked increase in the carbon monoxide level in the blood sufficient to interfere with oxygen binding of hemoglobin was observed in a 43-year-old man during the course of extracorporeal membrane oxygenator support for acute respiratory failure from viral pneumonitis. The increased carbon monoxide level in this man was temporally related to the transfusion of large amounts of old bank blood. The etiology of an increased level of carbon monoxide in the blood during extracorporeal circulation is discussed and solutions to this problem are suggested.
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PMID:Carbon monoxide accumulation during extracoporeal membrane oxygenation for acute respiratory failure. 97 68

An 11-year-old boy with acute lymphoblastic leukemia in remission developed a bilateral pneumonia which rapidly progressed to acute respiratory failure. During 9 days of intensive therapy the patient's respiratory status progressively deteriorated. When it became impossible to maintain the arterial oxygen tension (PAO2) above 40 mm.Hg by conventional means, extracorporeal blood-gas exchange with a membrane lung was begun. After 5 days of bypass the patient's respiratory function began to improve, and he was weaned from the membrane lung on the tenth day. Seven days later he was discharged from the hospital and is currently in excellemt health 23 months after bypass. This perfusion, the longest successful effort to provide respiratory assist with a membrane lung, attests to the efficacy of this therapeutic modality.
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PMID:Acute respiratory failure. Survival following ten days' support with a membrane lung. 113 20

Prolonged extracorporeal oxygenator support for acute respiratory failure is a clinical reality. Recent experience with 4 patients has demonstrated an advantage in delivery of saturated blood to the root of the aorta during venoarterial (VA) bypass. We have been able to perfuse the heart and bilateral cerebral hemispheres by advancing the tip of a large perfusion cannula to the aortic root from the common femoral artery. When the catheter did not pass beyond the transverse aortic arch, there was marked asymmetry of oxygenator perfusion, as determined by differential oxygen tension in right and left radial artery blood and by xenon-133 scans following isotope injection into the arterial return line. Long-term VA bypass lasting from 5 to 11 days resulted in long-term survival in 2 patients with post-traumatic gram-negative pneumonitis. The other patients, who had viral pneumonitis and post-transfusion respiratory failure, died after 9 and 11 days of membrane oxygenator support. No embolic lesions or arterial or valvular injuries were discovered at autopsy. This is a safe and useful method of providing oxygenated blood to the aortic root for equal distribution to the rest of the body.
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PMID:Cannulation of the proximal aorta during long-term membrane lung perfusion. 117 76

An autopsy case of dermatomyositis (DM) associated with interstitial pneumonia probably due to cytomegalovirus infection is reported. After corticosteroid therapy for 1 month, a 79-year-old man with DM developed acute respiratory failure due to interstitial pneumonia and died in spite of intensive respiratory care. By polymerase chain reaction method (PCR), DNA of cytomegalovirus (CMV) was detected in the bronchoalveolar lavage fluid (BALF). CMV was also detected by the method of conventional virus culture from BALF. These findings suggested that initial infection or reactivation of CMV had occurred in the lungs. The autopsy specimen revealed the findings of interstitial pneumonia compatible with CMV pneumonitis, but without the presence of intranuclear inclusion bodies. Although the present case of interstitial pneumonia should not strictly be diagnosed as definite CMV pneumonitis without the presence of intranuclear inclusion bodies in the lung tissue, initial infection or reactivation of CMV in the lungs may have contributed to the pathogenesis of interstitial pneumonia. In other cases of collagen vascular disease associated with interstitial pneumonia, CMV or other viruses may contribute to the pathogenesis of interstitial pneumonia.
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PMID:[An autopsy case of dermatomyositis associated with interstitial pneumonia probably due to cytomegalovirus infection]. 133 61

Acute respiratory failure in pregnancy is an important cause of maternal and fetal morbidity and mortality. Causes include: ARDS, venous air embolism, beta-adrenergic tocolytic therapy, asthma, thromboembolic disease, pneumothorax, and pneumomediastinum. The most common predisposing diseases for ARDS complicating pregnancy are sepsis, pneumonia, aspiration of gastric contents, and amniotic fluid embolism. Knowledge of normal maternal-fetal physiology and determinants of fetal oxygen delivery (uterine blood flow, placental transfer, fetal circulation) can help sustain normal fetal development, usually without compromising maternal care. The increased microvascular permeability seen in ARDS is likely mediated by neutrophils, proinflammatory mediators (e.g., tumor necrosis factor, interleukin-1, arachidonic acid metabolites) and activation of the complement cascade. Treatment of respiratory failure in pregnancy is largely supportive, including mechanical ventilation, hemodynamic support, nutrition, and prophylaxis against thromboembolism. No specific therapy has as yet been proven effective for ARDS, other than treating the underlying cause. Respiratory failure from status asthmaticus is treated with vigorous bronchodilator therapy, high-dose glucocorticosteroids, magnesium sulfate, and careful ventilator management. Occasionally, more experimental therapies (e.g., isoproterenol infusion, halothane anesthesia) are indicated. Certain strategies can help prevent respiratory failure from aspiration of gastric contents, beta-adrenergic tocolytic therapy, and thromboembolic disease.
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PMID:Acute respiratory failure in pregnancy. 136 44

Serum amylase level was determined in 129 cases (225 episodes) of chronic respiratory failure at acute exacerbation and in 59 cases (62 episodes) of pneumonia without respiratory failure as control. Cases with accompanying diseases, such as acute pancreatitis, parotiditis, ileus and renal dysfunction, which were expected to develop hyperamylasemia were excluded. The 225 episodes were divided according to the causes of acute exacerbation into 4 groups: pneumonia, bronchitis, right heart failure without infection, and others (e. g. hemoptysis). Hyperamylasemia (greater than 400 S-U) was observed in groups of pneumonia (15/40 = 35.5%) and bronchitis (12/95 = 12.6%), respectively but not in those of right heart failure without infection (0/73 = 0%) and other causes (0/17 = 0%). As a result, hyperamylasemia was found only under conditions of inflammation of lung parenchyma and bronchi with acute exacerbation of respiratory failure. On the other hand no hyperamylasemia was observed in 62 episodes of pneumonia alone without respiratory failure. It was concluded that both respiratory tract infection and acute respiratory failure are necessary factors for development of hyperamylasemia originating from lung or bronchi.
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PMID:[Hyperamylasemia in acute exacerbation of patients with chronic respiratory failure]. 138 26

Severe acute respiratory failure of varying etiology may require the temporary use of artificial gas exchange devices. So far, extracorporeal membrane oxygenation and extracorporeal carbon dioxide removal have been used successfully for this purpose. A totally implantable intravascular oxygenator (IVOX) recently became available. The authors have used IVOX in three patients who presented with severe respiratory failure secondary to pneumonia (n = 2) and post-traumatic adult respiratory distress syndrome (n = 1). At the time of implantation, all patients had hypoxemia (PaO2 less than 60) despite a 100% inspired oxygen concentration and forced mechanical ventilation. The duration of IVOX therapy ranged from 12 to 71 hr. All patients initially showed improvement in arterial oxygenation, allowing for moderate reduction of ventilator therapy after several hours. In one patient the pulmonary status deteriorated further, and she died from multiple organ failure despite IVOX therapy. One patient could be stabilized but died from other causes. The third patient is a long-term survivor 18 months after IVOX therapy. Gas transfer capabilities of IVOX are limited when compared to extracorporeal membrane oxygenation, and this may restrict its clinical applicability in cases of severe adult respiratory distress syndrome. However, IVOX may be used successfully in selected patients with less severe respiratory failure.
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PMID:Intravascular oxygenation for advanced respiratory failure. 142 5


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