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Query: UMLS:C0034063 (pulmonary edema)
 10,665 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A retrospective review of 114 solid organ donors over a 6-year period (1982-1987) was undertaken to identify problems in organ donor management and determine outcome of donated organs. Admission GCS was less than or equal to 4 in 84% of the donors. Complications included hypotension (81%), multiple transfusion requirements (63%), diabetes insipidus (53%), DIC (28%), arrhythmias (27%), cardiac arrest requiring CPR (25%), pulmonary edema (19%), hypoxia (11%), acidosis (11%), seizures (10%), and positive bacterial cultures (10%). Only 18% of organs were procured within 3 hours of brain death; 23% were procured more than 6 hours later. Six patients excluded from this study suffered cardiovascular collapse before their organs could be retrieved. From 114 organ donors, consent was obtained to procure 224 kidneys, 77 livers, 62 hearts, 35 pancreata, and ten heart-lung units. All 224 donated kidneys were procured and 202 were ultimately transplanted. Of 77 donated livers, 32 were procured; 31 transplanted. Of 62 donated hearts, 38 were procured; 29 transplanted and nine used for valves. Ten heart-lung units were donated; six were procured and transplanted. Of 35 donated pancreata, 11 were procured; only five were transplanted. Reasons for failure of donated organs to be procured or transplanted included abnormal organ characteristics, lack of compatible recipients, unavailability of surgical teams, organ injury during procurement, intraoperative arrest, and anatomic limitations precluding multiple organ procurement. This study identifies characteristics of organ donors and common organ-threatening complications. Rapid and continuing resuscitation of clinically brain dead trauma victims is mandatory.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Organ donor management and organ outcome: a 6-year review from a Level I trauma center. 235 1

A porcine model of cardiac arrest with irreversible electromechanical dissociation was associated with highly significant decreases in colloid osmotic pressure in the absence of increases in hematocrit during the initial half hour of CPR. Pulmonary edema was typically observed. These observations are best explained by increases in capillary permeability to plasma proteins. The progression of acidemia was remarkably slow; arterial blood pH remained normal for more than 16 min. Even though there was significant lactic acidosis, concurrent respiratory alkalosis during CPR accounted for the greatly delayed onset of acidemia. There was also an as-yet unexplained increase in plasma osmolality.
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PMID:Observations on colloid osmotic pressure, hematocrit, and plasma osmolality during cardiac arrest. 393 78

Previous studies have shown that pulmonary edema occurs in half of all pre-hospital cardiac arrest victims who cannot be successfully resuscitated and is a major cause of hypoxemia and poor lung compliance during resuscitation. Pulmonary vascular hypertension and elevation of pulmonary capillary wedge pressure have been observed during cardiac resuscitation in humans. To further define the time course of the pulmonary hemodynamic changes, pulmonary artery diastolic pressure (PAd) was measured on a computerized trend recorder prior to, during, and immediately after arrest in three adult patients. Prior to arrest, PADP was 20.9 +/- 3.1 mm Hg. The PADP rose in all three patients by an average of 30.6% after 5-10 minutes and 71.3% after 10-15 minutes of CPR. Peak PADP reached 35.8 +/- 5.1 mm Hg (difference from pre-arrest level significant, P less than 0.001). In both patients who were resuscitated successfully, the PADP returned to baseline within 5 minutes of effective spontaneous circulation. The finding that such hemodynamic changes occur rapidly during resuscitation and can reverse quickly with resumption of effective spontaneous circulation is consistent with the time course for the early development of pulmonary edema. Development of pulmonary edema many hours following successful resuscitation likely involves other mechanisms.
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PMID:Rapid change in pulmonary vascular hemodynamics with pulmonary edema during cardiopulmonary resuscitation. 397 Jul 68

The Fourth Purdue Conference on Cardiac Defibrillation and Cardiopulmonary Resuscitation identified needed defibrillation research, including an appropriate animal model, threshold validity, effects of polarity, and an easy-to-operate defibrillator. CPR research needs include better protocols, hemodynamics and survival studies, the role of pulmonary edema, re-examination of sudden death, and transchest pacing.
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PMID:Some research needs in defibrillation and CPR. 613 10

PEEP ventilation is frequently used in intensive care patients: its particular effects in the immediate treatment of emergency patients are discussed. In animal experiments different studies were performed using manually operated resuscitators combined with a newly designed PEEP valve. The most important results in neonatal pigs show that the post partum compliances and the neonatal PO2 values were much better after primary PEEP ventilation than after IPPB or 2-phases unfolding inflation. The worst method of respiratory resuscitation is the use of PNPB. In 2 other groups of animals immediate PEEP ventilation was compared to IPPB, after 25 ml of fresh water/kg BW had been instilled into the animals lungs. The PaO2 and AaDO2 values of those animals, treated immediately with PEEP were much better than the corresponding values of the ZEEP group animals. But, the PEEP-treated animals showed a significant reduction of the cardiac output. The article deals further with the results of different authors, as far as PEEP and lung edema, PEEP and CPR, PEEP and shock are concerned. In our opinion, the present clinical and experimental results lead to the following conclusions: The immediate PEEP ventilation at the scene is indicated 1. in neonatal resuscitation - 2. in near drowning - 3. in lung edema - 4. in cardiopulmonary resuscitation. PEEP ventilation should however not exceed 10 cm H2O.
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PMID:[Aspects of primary PEEP ventilation for immediate treatment of emergency patients (author's transl)]. 677 51

Determining adequacy of mechanical ventilation is as important during CPR as in a more stable situation (such as, a patient on a ventilator in an ICU). Yet, such assessment during CPR usually only means listening for breath sounds, checking chest excursion, and blood gases. Exhaled tidal volume (VT) was measured on 45 intubated adult patients during resuscitation using a Wright's spirometer attached to a T-valve above the endotracheal tube. Ten patients had aspiration prior to intubation; 15 received advanced cardiac life support in the field, including esophageal airway insertion. CPR was performed in all cases with a mechanical compression device (Thumper). The pressure ventilator on this device was calibrated (peak inspiratory pressure, VT vs compliance) using a Dixie Test Lung, allowing indirect assessment of pulmonary compliance during CPR. Our findings suggest that lung compliance is markedly reduced within a short time after cardiac arrest. Fifty-five % of patients in this series could not be adequately oxygenated (PaO2 less than 50 torr) despite an FIO2 of 0.8 and adequate ventilation. Due to the reduced cardiac output during CPR causing venoarterial shunting, it is speculated that pulmonary edema is the most plausible explanation for this observation.
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PMID:Measurement of ventilation during cardiopulmonary resuscitation. 682 84

Although severe pulmonary edema is encountered occasionally in patients needing CPR, there has been no definitive description on the mortality and morbidity of pulmonary edema after CPR. The author experienced severe pulmonary edema after standard CPR in 20 of 71 patients who suffered sudden, unexpected cardiac arrest and regained heart function by CPR. The varied onset of pulmonary edema, which may have developed when massive pink frothy secretions exited from the endotracheal tube, ranged from a few minutes to 45 min after the re-establishment of heart beat. These 20 patients showed a significantly higher P(A-a)O2, insignificant lower plasma protein concentrations, and high plasma osmolarities as compared with those who did not develop pulmonary edema. Only 2 patients with pulmonary edema survived. During CPR, many factors could cause pulmonary edema, including external cardiac massage (ECM), administration or release of catecholamines, hypoxia, acidosis, overhydration, etc. This study indicates that patients who need CPR have a high likelihood of developing pulmonary edema.
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PMID:Postcardiopulmonary resuscitation pulmonary edema. 685 1

Significant hypothermia is an increasing clinical problem that requires a rapid response with properly trained personnel and techniques. Although the clinical presentation may be such that the victim appears dead, aggressive management may allow successful resuscitation in many instances. Initial management should include CPR if the victim is not breathing or is pulseless. Further core heat loss should be prevented by removing wet garments, insulating the victim, and ventilating with warm humidified air/oxygen to help stabilize core temperature. Core temperature and cardiac rhythm should be monitored in the prehospital setting, if possible, and CPR should be continued during transport. In-hospital management should consist of rapid core rewarming in the severely hypothermic victim with heated humidified oxygen, centrally administered warm IV fluids (43 C), and peritoneal dialysis until extracorporeal rewarming can be accomplished. Postresuscitation complications should be monitored; they include pneumonia, pulmonary edema, cardiac arrhythmias, myoglobinuria, disseminated intravascular thrombosis, and seizures. The decision to terminate resuscitative efforts must be individualized by the physician in charge.
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PMID:Hypothermia. 843 36

Takotsubo syndrome is rare in pediatric patients but must be considered in patients with subarachnoid hemorrhage with pulmonary edema and cardiomyopathy. A systematic, collaborative approach is needed to facilitate emergent transfer of patients where extracorporeal cardiopulmonary resuscitation (e-CPR) is used as a lifesaving measure. Extracorporeal membrane oxygenation (ECMO) use in transport requires preplanning, role delineation, resources, and research efforts to be successful. We present an unusual transport case of successful e-CPR/ECMO treatment of Takotsubo syndrome in a 12-year-old boy with an isolated traumatic intracranial injury, cardiomyopathy with pulmonary edema, and multiple cardiac arrests.
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PMID:Pediatric Extracorporeal Cardiopulmonary Resuscitation Patient With Traumatic Subarachnoid Hemorrhage and Takotsubo Syndrome. 2947 85