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Query: UMLS:C0476273 (respiratory distress)
 19,632 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pulmonary endothelial cells form a continuous monolayer on the luminal surface of the lung vasculature. Until the mid-1970s, the pulmonary endothelium was felt to provide little more than a passive surface for the exchange of gases, water, macromolecules, and some cell traffic. Recent evidence indicates that the pulmonary endothelium is a metabolically active surface, which provides a regulatory interface for the continual processing of blood-borne vasoactive molecules, plays an active role in hemostasis and immunologic and inflammatory events, regulates vascular tone, and interacts with inflammatory cells and neighboring vascular cell types. These metabolic properties are both constitutive and capable of being induced in response to stimuli or injury. Virtually any agent that causes pulmonary endothelial cell injury will lead to impairments in the functional metabolic properties of these cells, resulting in alterations in hemodynamics, hemofluidity, permeability, gas exchange, and intercellular signaling. The net result in the lung is often the clinical picture of acute lung injury with respiratory distress, refractory hypoxemia, diffuse alveolar infiltrates, and respiratory failure.
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PMID:Pulmonary endothelial cell pathobiology: implications for acute lung injury. 150 13

Intravascular and intra-alveolar thrombin generation may exacerbate the pulmonary hypertension and surfactant dysfunction that characterize the neonatal respiratory distress syndrome (RDS). Although low levels of the most important thrombin inhibitor, antithrombin III (AT III), have been reported in infants with RDS, direct evidence of increased intravascular thrombin generation has been lacking. Accordingly, the objective of this study was to determine whether thrombin generation is increased in severe neonatal RDS. Thirty-nine infants of 25 to 29 wk gestation with a clinical and radiologic diagnosis of RDS were enrolled in a prospective cohort study. Plasma levels of thrombin/antithrombin III complexes (TAT) and AT III activity, measured 36 to 72 h after birth, were related to RDS severity. Seventeen infants had severe RDS (mean airway pressure greater than 10 cm H2O or FlO2 greater than 0.8), and 22 had mild or moderate disease. Mean birthweight (1,017 versus 1,054 g) and mean gestational age (27.8 versus 27.4 wk) were similar in both groups. The median TAT level in infants with severe RDS was significantly higher than that in patients with mild or moderate disease (10.7 and 4.0 micrograms/L, respectively; p less than 0.001). In addition, the mean AT III activity in infants with severe RDS was significantly lower than that in less severely affected patients (0.31 and 0.46 U/ml, respectively; p less than 0.01). Considering the entire cohort, plasma TAT levels were inversely correlated with the arterial/alveolar oxygen tension ratio (r = -0.48, p = 0.0022) and the ventilator efficiency index (r = -0.51, p = 0.0011). The elevated TAT levels and reduced AT III activity in infants with severe RDS are consistent with increased thrombin generation and resulting AT III consumption. Therefore, to regulate thrombin activity, these infants may benefit from replacement therapy with AT III concentrate.
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PMID:Thrombin/antithrombin III complex formation in the neonatal respiratory distress syndrome. 155 99

The optimum level of positive end expiratory pressure (PEEP) was determined in 16 infants with respiratory distress syndrome (median gestational age 29 weeks, median postnatal age 1 day) and in 16 infants with chronic respiratory distress (median gestational age 25 weeks, median postnatal age 15 days). All infants were studied at a PEEP sequence of 3, 0, 3, 6, and 3 cm H2O, all other ventilator parameters being kept constant. Each PEEP level was maintained for 20 minutes and at the end of each period arterial blood gas was checked. During acute respiratory distress syndrome there were no significant changes in oxygenation but arterial carbon dioxide tension (PaCO2) significantly decreased from a mean of 4.93 kPa at 3 cm H2O to 4.40 kPa at 0 cm H2O and increased to a mean of 5.87 kPa at 6 cm H2O. In the infants with chronic respiratory distress, oxygenation fell from a mean of 8.66 kPa at 3 cm H2O to 6.40 kPa at 0 cm H2O and improved at 6 cm H2O to a mean of 10.50 kPa. There were no significant changes in PaCO2. We conclude that addition of PEEP, up to 6 cm H2O, may be useful even after the first week of life. High levels of PEEP, however, have previously been reported, in certain infants, to result in circulatory disturbance. It is therefore important to assess the use of 6 cm H2O PEEP in a controlled study of longer term clinical outcome.
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PMID:Positive end expiratory pressure in acute and chronic respiratory distress. 157 57

We have studied haemodilution and cardiovascular responses to i.v. hydration with either 3% dextran 70 (Dx70) or Ringer's acetate using a non-invasive cardiac output monitor (BoMed NCCOM3-R7) in 40 healthy parturients undergoing Caesarean section under extradural anaesthesia. Haemodilution was more pronounced, and central venous pressure, mean arterial pressure and cardiac index maintained at greater values, after treatment with Dx70. Colloid osmotic pressures (COP) decreased by 1.7 mm Hg after loading with 3% Dx70, and by 5.6 mm Hg in mothers treated with Ringer's acetate (P less than 0.001). The transthoracic fluid index decreased more after hydration with Ringer's acetate (P less than 0.001), indicating an increase in lung water. In spite of these maternal changes, there were no differences in neonatal bioimpedance or values of haemoglobin, PCV, albumin and COP in umbilical cord blood, and only one case of respiratory distress. We conclude that colloids may be preferable to crystalloids for circulatory preload for extradural Caesarean section, as greater haemodynamic stability was maintained and increases in lung water avoided.
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PMID:Comparison of Ringer's acetate with 3% dextran 70 for volume loading before extradural caesarean section. 206 92

In 19 anesthetized piglets 3 ventilatory modes were studied after inducing pulmonary insufficiency by bronchoalveolar lavage by the method of Lachmann. The lavage model was considered suitable for reproduction of severe respiratory distress. This model was reproducible and stable with respect to alveolar collapse, decrease in static chest-lung compliance and increase in extravascular lung water. The ventilatory modes studied were volume-controlled intermittent positive-pressure ventilation (IPPV), pressure-controlled inverse ratio ventilation (IRV), and pressure-controlled high-frequency positive-pressure ventilation (HFPPV). The 3 ventilatory modes were used in random sequence for at least 30 min to produce a ventilatory steady state. Ventilation with no PEEP, permitting alveolar collapse, was interposed between each experimental mode. The ability to open collapsed alveoli, i.e. alveolar recruitment, was different. The recruitment rate for IPPV was 74%, but for IRV and HFPPV it was 95%, respectively. Although IRV provided the best PaO2, this was at the expense of high airway pressures with circulatory interference and reduced oxygen transport. In contrast to this, HFPPV provided lower airway pressures, less circulatory interference and improved oxygen transport. In the clinical setting there might be negative effects on vital organs and functions unless the ventilatory modes are continuously and cautiously adapted to the individual requirements in different phases of severe respiratory distress. Therefore, one ventilatory strategy could be to "open the airways" with IRV, but then switch to HFPPV in an attempt to maintain the airways open with lesser risk of barotrauma and with improved oxygen transport.
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PMID:An experimental study of different ventilatory modes in piglets in severe respiratory distress induced by surfactant depletion. 174 8

Manual ventilation of neonates suffering from respiratory distress is frequently performed in the hospital setting. The authors hypothesized that without manometer feedback present, experienced neonatal intensive care therapists cannot accurately estimate ventilating pressures. We also speculated that with rate feedback present, this same group could match a given ventilatory rate. Thirty respiratory therapists (RTs) were instructed to match the ventilating pressures and rates for two animal models receiving ventilatory support. Each animal was ventilated at high pressure settings: peak inspiratory pressure (PIP) 25 cm H2O, positive end-expiratory pressure (PEEP) 5 cm, and a rate of 60 breaths per minute; the low pressure settings were PIP 16 cm H2O, PEEP 3 cm, and a rate of 20 breaths per minute. There was essentially no replication of the desired PIP values. PEEP levels were constant in the study population, but there was no accuracy in relation to the targets. Rate accuracy was good with the higher rate, but there was some statistical deviation from the given lower rate for both models. We conclude that in the presence of a cycling ventilator set at the desired rate, this group of therapists could replicate the cycling rate. However, without a means for feedback of ventilating pressures, dictated pressures could not be matched.
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PMID:Manual ventilation of adult cats by neonatal respiratory therapists. 177 Mar 89

Little is known of the endorphins' role in sepsis-induced respiratory distress and naloxone's effect as a treatment of it. Thirteen piglets were infused with live Escherichia coli at a rate of 2 to 10 x 10(8) colony-forming units per hour for six hours or until death and were divided into two groups: the septic control group (n = 8), and the naloxone-treated group (n = 5), which received 8 mg/kg/h of naloxone by continuous infusion. The results showed a significant reduction of QS/QT, VD/VT, and arterial carbon dioxide pressure at one hour and a significant increase of arterial carbon dioxide pressure and minute ventilation at 1, 3, and 4 hours in the naloxone-treated group, compared with the untreated septic group. None of the piglets in the naloxone-treated group developed ventilatory depression, while 75% of those in the untreated septic group did. Among the latter ficial effects of naloxone are likely related to its action on the central and peripheral respiratory regulatory mechanisms. A transient protection of the cardiac output and relatively decreased extravascular lung water with naloxone treatment may also, in part, improve the ventilation-perfusion maldistribution and secondarily reduce QS/QT and VD/VT.
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PMID:[Prevention of septic ventilatory depression with naloxone]. 181 74

Airsane HP 800 is a disinfectant widely used in hospitals as a powder to be diluted in water. It mainly contains a mixture of quaternary ammonium compounds. Forty five cases of acute accidental poisoning with this product have been reported to the Paris Poison Centre. All the victims were mentally disturbed patients: 2 were young adults hospitalized in psychiatric units and the other 43 were old people hospitalized for senile dementia. All ingested the solid preparation which was left in their room by hospital workers who did not know it was dangerous. Corrosive burns of the mouth, pharynx, oesophagus and sometimes of the respiratory tract were produced in most patients. Thirteen of them died. All were old persons. Ten had inhalation pneumonitis and died of acute respiratory distress one hour to twelve days after taking the powder. Progressive deterioration was responsible for the death of the other three between the 19th and 40th days. These severe accidental poisonings could easily be prevented by a better information of hospital workers, and by storing the disinfectant and preparing the solution beyond the reach of patients.
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PMID:[Acute accidental poisoning with hospital disinfectant. 45 cases of which 13 with fatal outcome]. 182 91

Studies were conducted on haematological constituents such as Red blood cells (RBC), White blood cells (WBC), Haemoglobin (Hb), Packed cell volume (PCV), Mean cell volume (MCV), Mean corpuscular haemoglobin (MCH), Mean corpuscular haemoglobin concentration (MCHC), Blood volume (BV), Blood water content (BWC) and Whole animal oxygen consumption (WAOC) in the fish exposed to sublethal concentration of atrazine. Significant changes were seen in the constituents of the blood and O2 consumption of fish suggesting the existence of respiratory distress in the fish as a consequence of atrazine toxicity.
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PMID:Effect in vivo of atrazine on haematology and O2 consumption in fish, Tilapia mossambica. 186 69

Because of cocaine's possible effect on the incidence of respiratory distress syndrome in offspring of cocaine-addicted mothers, we have studied the effects of maternal exposure to cocaine on the functional anatomy of fetal rabbit lungs. Pregnant dams were injected s.c. daily with either cocaine (18 mg/kg) or an equal volume of 0.9% NaCl at 24, 25, and 26 d gestation. Cocaine metabolites were confirmed both in urine of treated dams and in fetal amniotic fluid. Serum cortisol levels were higher in treated dams than in controls. Fetuses were delivered through hysterotomy at 27 d. Tracheas were cannulated and a volume-pressure diagram was obtained during initial lung inflation-deflation. Volume was measured for 2 min at each pressure (P) increment of 5 cm H2O. Body weights and dry lung weights were comparable between the two groups. In contrast, cocaine-exposed lungs differed from controls as follows: 1) wet lung weights were lower (0.79 versus 0.89 g, p less than 0.02); 2) opening pressure was lower (P25 versus P35); 3) volume (mL/kg) was higher in treated animals at each pressure step (p less than 0.05); 4) end-deflation volume at P0 was higher (30.4 versus 0.8 mL/kg, p less than 0.001); and 5) bubbles released from saccules by micropuncture, which were stable by Pattle's criteria, had estimated surface tension near zero (controls produced no stable bubbles). Light micrographs of cocaine-exposed fetuses revealed more secondary septa and thinner septal walls than controls.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Enhanced lung maturation in cocaine-exposed rabbit fetuses. 186 7


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