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

Acute respiratory failure has a high mortality in patients with acquired immunodeficiency syndrome (AIDS). This study was undertaken to determine the etiology of acute respiratory failure and the outcome of children with AIDS and AIDS-related complex. Records of 31 children with AIDS or AIDS-related complex admitted to the pediatric intensive care unit for acute respiratory failure throughout a 46-month period were reviewed. Acute respiratory failure was due to Pneumocystis carinii pneumonia in 13, cytomegalovirus pneumonia in six, bacterial pneumonia in five, severe bacterial sepsis in four, Candida pneumonia in two, and a giant cell pneumonia in one patient. In addition, 11/19 patients with acute respiratory failure due to P carinii pneumonia or cytomegalovirus had superinfections with bacteria or Candida. Of the total of 19 primary and secondary bacterial infections, Pseudomonas aeruginosa was responsible in ten and Klebsiella pneumoniae in three children. Five children (16%) survived until pediatric intensive care unit discharge; three died within 6 months. The causes of acute respiratory failure were not significantly different in survivor and nonsurvivor groups. It is concluded that, in addition to P carinii pneumonia and cytomegalovirus pneumonia, bacterial infections (especially due to Pseudomonas and other Gram-negative organisms) are important causes of respiratory failure. The high mortality and grim ultimate prognosis seen may have implications for pediatricians attempting to identify the proper limits of medical intervention for this group of patients.
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PMID:Respiratory failure in children with acquired immunodeficiency syndrome and acquired immunodeficiency syndrome-related complex. 326 Oct 5

Ten patients with acute respiratory failure (ARF), (4 pneumonia, 4 sepsis, 2 polytrauma), underwent computerized tomography (CT) of the lungs, (apex, hilum, base), at 5, 10, 15 cm H2O positive end expiratory pressure (PEEP). The ARF lungs, on CT scan, appeared as a patchwork of normal and dense areas with generally well defined boundaries. Most of the densities were found in the dependent regions. The areas of density were correlated with PaO2 (r = 0.51). The PEEP increase resulted in a significant expansion of total cross-sectional lung surface area. The dense areas decreased significantly at the hilum and base when increasing PEEP while the changes at the apex were not significant. The changes of density with PEEP were highly correlated with the changes in oxygenation (r = 0.91). In the individual patient, however, the modifications of gas exchange can not be entirely predicted from morphological changes, possibly due to a diversion of pulmonary blood flow.
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PMID:Morphological response to positive end expiratory pressure in acute respiratory failure. Computerized tomography study. 352 33

Plasma colloid osmotic pressure (COP) was measured in three groups of very low birthweight infants. Babies in Group 1 (n = 8) were breathing spontaneously and had no respiratory disease. Those in Group 2 (n = 9) received assisted ventilation for hyaline membrane disease (HMD), and those in Group 3 (n = 7) received assisted ventilation for other reasons (five apnoea, two pneumonia). Both assisted ventilation groups had lower mean COP values than spontaneously breathing infants. Mean values (s.e.m.) for Groups 1, 2 and 3, respectively, were: 15.3 (0.6), 11.3 (0.4) and 11.9 mmHg (0.5) (P less than 0.001) on Day 1; and 15.2 (0.4), 12.9 (0.4) and 12.8 mmHg (0.3) (P less than 0.001) on Day 2. The increase from Day 1 to Day 2 was significant for those with HMD (P less than 0.05). Colloid osmotic pressure correlated with mean blood pressure (r = 0.51; P less than 0.001) but not with birthweight, gestation, crystalloid fluid intake or pH. The role of low COP in the pathogenesis of acute respiratory failure in infants with uncomplicated HMD is unclear, but such low COP may contribute to development of pulmonary oedema as a complication, particularly if the ductus arteriosus is still patent and the infants are given high volume intravenous fluids.
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PMID:Low colloid osmotic pressure in very low birthweight infants receiving assisted ventilation. 366 82

Two patients were admitted directly to our Intensive Care Unit in acute respiratory failure due to pneumonia with septicaemic shock, renal and hepatic impairment. Sputum and blood cultures failed to grow any organisms and despite broad spectrum antibiotic therapy for 7 days, neither patient improved. Diagnosis of the rare pneumonic form of psittacosis was made following a raised titre. After treatment with tetracyclines, both patients made a rapid recovery. Retrospective direct questioning revealed that they had close contact with psitacine birds.
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PMID:Psittacosis: diagnosis and management of severe pneumonia and multi organ failure. 366 76

Of approximately 6000 admissions to the Henry Ford Hospital medical ICU between October 1969 and September 1984, 61 (1%) had active tuberculosis (TB). Forty-three (70%) of these 61 had acute respiratory failure (ARF). TB was considered to be the sole cause of ARF in 12 and contributory in 31. Eighteen patients with TB but without ARF were admitted for treatment of other critical illnesses. Alcoholism was present in 31 (51%) of the TB patients. Only one of 12 whose ARF was caused primarily by TB had a history of known TB at the time of admission. Important factors contributing to ARF in TB patients included Gram-negative pneumonia and/or sepsis, chronic obstructive pulmonary disease, prior TB with anti-TB medication noncompliance, and malignancy. Six patients were not suspected of having TB when admitted to the medical ICU; three patients who had not been treated for TB were found to have TB on autopsy. The inhospital mortality rate for all patients with TB requiring intensive care was 67%, but was 81% in those with ARF.
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PMID:Active tuberculosis in the medical intensive care unit: a 15-year retrospective analysis. 367 43

Patients requiring prolonged (greater than 24 hours) mechanical ventilation have various conditions that result in respiratory failure. All patients requiring prolonged mechanical ventilation were subdivided into the following six groups: uncomplicated acute lung injury; respiratory failure complicated by multisystem failure; previous lung disease; trauma; other medical causes; and routine postoperative ventilation. During a one-year period, 327 patients required prolonged mechanical ventilation; acute lung injury and chronic obstructive pulmonary disease were the predominant conditions. Sepsis was both the major predisposing factor for and complication of acute lung injury. Mortality for patients with acute lung injury was 40 percent in the uncomplicated group and 81 percent in patients with acute lung injury complicated by multisystem failure. Acute respiratory failure in association with acute renal failure had a mortality of 89 percent. Number of organ systems involved also correlated with mortality. In patients with chronic obstructive pulmonary disease and pneumonitis or retained secretions, mortality was lower (30 percent), but a significant percentage of these patients (43 percent) became ventilator-dependent. Ventilator dependence did not significantly increase mortality during the course of respiratory failure.
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PMID:Clinical outcome of respiratory failure in patients requiring prolonged (greater than 24 hours) mechanical ventilation. 374 48

The clinical, radiographic, and pathologic correlates of acute respiratory failure due to Pneumocystis carinii pneumonia were studied in 12 renal transplant patients treated with cyclosporin (CS) and prednisone. Six patients required only supplemental oxygen, while the other six patients developed the adult respiratory distress syndrome (ARDS) requiring prolonged mechanical ventilation despite similar predisposing factors and prompt initiation of therapy. Ten (83%) patients survived. Increased frequency of human leukocyte antigen (HLA) DR6 was noted in six of the 11 patients tested. The resolution of radiographic infiltrates was significantly slower in ARDS patients; however, there was no apparent difference in the severity of early alveolar damage between the two groups. There was also no association between the development of ARDS due to P. carinii pneumonia and the mean daily dose of CS and prednisone, the presence of cytomegalovirus infection or pneumonia, HLA-DR6 antigen, or initial hypoxemia.
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PMID:Acute respiratory failure due to Pneumocystis carinii pneumonia: clinical, radiographic, and pathologic course. 388 75

Controlled mechanical ventilation is an accepted therapy for acute respiratory failure but by virtue of the increase in intrathoracic pressure has a large number of disadvantages. It is to overcome these disadvantages that alternative modes of ventilation have been introduced. These aim to reduce the effects of abnormally high airway pressure on the lung whilst recruiting solid alveoli and at the same time maintaining effective blood volume. Intermittent mandatory ventilation is a mode of ventilation first introduced to aid weaning which may reduce the need for sedation, permit better tolerance of high levels of PEEP and maintain urine osmolar output. High frequency ventilation utilising low airway pressures can maintain pulmonary gas exchange whilst reducing the effects of stretch on the lung. Its major role would seem to be in cases of bronchopleural fistula and necrotising pneumonia where a low mean airway pressure is essential. Low frequency positive pressure ventilation with extra corporeal CO2 removal, whilst a very labour intensive technique, has produced a favourable outcome in patients with terminal respiratory failure. Use of PEEP is associated with further deleterious haemodynamic effects which are largely overcome with use of continuous positive airway pressure during spontaneous respiration. PEEP is widely used. Its effect on pulmonary compliance, dead space and oxygen delivery are unpredictable making haemodynamic monitoring mandatory. Inversed ratio ventilation requires further evaluation whereas differential lung ventilation is logical, complicated but very valuable where the time constants for each lung are significantly different.
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PMID:Alternative modes of ventilation. Part I. Disadvantages of controlled mechanical ventilation: intermittent mandatory ventilation. 388 40

Bacillus species are identified as pathogens in lung and pleural space infections with increasing frequency. We report a patient who developed life-threatening complications of Bacillus cereus pneumonia, including massive hemoptysis, acute respiratory failure, tension pneumothorax, empyema, and bronchopleural fistula. We also review the pertinent literature concerning the associated underlying disorders, complications, and therapy of Bacillus species pulmonary infections.
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PMID:Life-threatening complications associated with Bacillus cereus pneumonia. 391 26

The use of asynchronous independent lung ventilation is described in a patient presenting with acute respiratory failure due to a severe unilateral pneumonia. A polyvinyl chloride (Portex) double-lumen tube was inserted through a tracheostomy and the lungs ventilated independently using a combination of a Cape ventilator and a Servo 900B ventilator.
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PMID:Asynchronous independent lung ventilation. Its use in the treatment of acute unilateral lung disease. 397 33


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