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

Death in the late stage of Duchenne muscular dystrophy is most frequently a consequence of respiratory failure. Since muscles of ventilation become weakened the bellows mechanism fails insidiously. Patients exhibit symptoms of ventilatory insufficiency, the first to be noticed are those associated with CO2 retention: dyspnea, nightmares, increased heart rate, and increased blood pressure. Ten patients with late stage Duchenne muscular dystrophy have been supplied with mechanical aid for ventilatory assistance. The age of onset of respiratory distress needing mechanical assistance varied from 10 to 20 years. Meaningful survival after allegedly reaching the end stage has been from 2 to 7.5 years with an average of 3.4 years. With a caring family, these patients can have a meaningful life, even though they require continuous mechanical ventilatory aid.
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PMID:Mechanical ventilation of patients with late stage Duchenne muscular dystrophy: management in the home. 45 24

We designed a system consisting of a nostril adapter and a catheter for measurement of end-tidal ("alveolar") CO2 in small infants using the Beckman LB-1 analyzer. Using this system, we obtained a capillary-"alveolar" PCO2 difference (PaCO2-PACO2) of 2.4 Torr in 19 normal term infants, 3.5 Torr in 12 preterm infants who had recovered from respiratory distress syndrome, and 9.0 Torr in 4 preterm infants with bronchopulmonary dysplasia. We also found in 5 infants that systems using faster flow rates (140-400 ml-min-1) or slower response times (greater than 0.3 s) reduced the duration of the alveolar plateaus as well as the calculated end-tidal PCO2. In addition, when term infants were not in a steady state, PACO2 values were unreliable and significantly lower than capillary values. We therefore conclude that measurement of alveolar CO2 using our technique is a simple noninvasive way of evaluating newborn pulmonary function.
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PMID:A simple technique for measuring alveolar CO2 in infants. 71 83

The indices of P a-A CO2, P A-a O2 and VD/VT were evaluated in a group of children treated with controlled ventilation (IPPV) for: pneumonia, congenital heart disease, respiratory distress syndrome or central nervous system diseases. The P A-a O2 index is regarded as the most useful one, since it enables the possibility to select a F IO2 value for obtaining an optimal P aO2. For calculation of VD/VT according to Bohr's formula during connection of the child to respirator P ECO2 was determined planimetrically from the capnographic curve. P a-A CO2 was recognized as a less useful index and difficult to interpret.
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PMID:Evaluation of P a-A CO2, P A-a O2 and VD/VT measurements during controlled respiration in children. Preliminary communication. 79 76

In postoperative patients one frequently observes respiratory difficulty in excess of what is indicated by physical alterations in respiratory mechanics. This would suggest that some patients lack normal compensatory mechanisms which respond to mechanical changes in the lung. It is entirely possible that inadequacy of compensatory mechanisms is present before surgery and predisposes patients to respiratory distress. In the clinical environment elaborate testing is precluded by the physical status of the patients. Thus, a noninvasive procedure has been designed to apply stress to the respiratory system in order to study the effect of stress at increasing levels of CO2. In this test a subject's respiration is measured as he rebreathes a mixture of 7% CO2 and 93% O2 from a closed system. On successive trials, fixed pressure inspiratory threshold loads are applied in sequence. With this type of load the increased work required to inspire a given volume depends only on the increased inspiratory pressure. In most normal subjects CO2 response was incrementally depressed when threshold loads were introduced. Patients with brain stem lesions showed a greater depression at higher loads. This may indicate a reduced ability to tolerate increased loads to breathing.
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PMID:Ventilatory responses to threshold loaded respiration in man. 90 Jun 46

Respiratory distress occurs in infants with myelomeningocele and Arnold-Chiari malformation. It is difficult to measure it because of the small volume exchanged and the lack of cooperation of infants. Existing equipment had to be modified to do so by decreasing the dead space and reducing the bulkiness of the sensing device. In infants with tracheostomies, a continuous flow of gas was applied to reduce the dead space. In infants without tracheostomies, a continuous flow of gas was applied, but the mask was too bulky to seal around the baby's face. A nose-piece pneumotachograph was developed to alleviate the problem. Respiration was measured in 15 patients with myelomeningocele and hydrocephalus from 1 day to 5 months of age. After gas was administered, they breathed 38.5 times a minute with a tidal volume of 6.25 ml/kg, producing a minute ventilation of 0.2541/min/kg. After administration of 5 per cent CO2-95 per cent O2, respiratory frequency rose to 47 breaths a minute, with a tidal volume of 8.8 ml/kg, producing a minute ventilation of 0.4101/min/kg, comparable to that of normal infants.
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PMID:Measurement of respiration in Arnold-Chiari malformation. 127 51

In respiratory support of patients with acute respiratory distress syndrome (ARDS), the extracorporeal CO2 removal (EC CO2R) technique should be the earliest and easiest procedure so as to have the lowest blood flow rate. Extracorporeal circulation (ECC) can be achieved using an oxygenator for CO2 removal under the dry form (dissolved CO2) or a hemodialyser for CO2 removal under the wet form (bicarbonates). This study investigated different methods allowing an increase in CO2 transfer, using liquid flow rates up to 0.330 l/min. The experimental set-up employed heated (38 degrees C) aqueous polyelectrolytic solutions mimicking the venous blood (pH 7.20, PCO2 53 mmHg). Four in vitro methods were tested: Series I: a DIDECO D702 oxygenator without blood (= liquid) acidification, Series II: D702 oxygenator with inlet HCl acidification, Series III: a HOSPAL H10-10 hemodialyzer without dialysate alkalinisation, Series IV: H10-10 hemodialyzer with NaOH dialysate alkalinisation. Maximum gas flow in the oxygenator and dialysate rate in hemodialyzer were 5 and 0.55 l/min respectively. For the four series the CO2 transfer (TCO2) (mean +/- S.E. ml/min) and pH out were: [table: see text] The difference between the four series was statistically significant (t-test). Acidification using the oxygenator increased CO2 transfer by 80%, but CO2 elimination was better with hemodialysis.
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PMID:EC CO2R: oxygenator or hemodialyzer? An in vitro study. 158 45

The purposes of this study were to evaluate the clinical utility of a colorimetric end-tidal CO2 (ETCO2) detector in confirming proper endotracheal intubation in patients requiring emergency intubation, to determine if this new device can be used as an adjunct to judge the effectiveness of cardiopulmonary resuscitation (CPR), and to determine whether the device can predict successful resuscitation from cardiopulmonary arrest. We studied prospectively 110 patients requiring emergency intubation for either respiratory distress (53 patients) or cardiopulmonary arrest (57 patients) by recording the color range of the indicator after the initial intubation. In patients who suffered a cardiopulmonary arrest, the color range was also recorded during CPR after the endotracheal tube was confirmed to be in the tracheal position and perfusion optimized, and at the moment CPR was stopped. The ETCO2 detector was 100% specific for correct endotracheal intubation in all patients. It was also highly sensitive (0.98) for correct endotracheal intubation in patients with respiratory distress. However, it was not sensitive (0.62) in patients with cardiopulmonary arrest and low perfusion. The sensitivity improved (0.88) when we used the ETCO2 range obtained after attempts to increase perfusion. A low ETCO2 color range in 19 patients undergoing CPR was interpreted as low cardiac output and prompted the physicians to attempt to increase perfusion. Of the patients who underwent CPR, no patient whose ETCO2 level remained less than 2% was successfully resuscitated. Those patients who had an ETCO2 level greater than or equal to 2% had a significantly higher incidence of successful resuscitation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical utility of a colorimetric end-tidal CO2 detector in cardiopulmonary resuscitation and emergency intubation. 174 72

We have conducted a retrospective survey of 79 children out of a total hospital asthmatic patient population of 2,412, admitted over a 32 month period to the ICU for the management of severe status asthmaticus. All patients were in severe respiratory distress with CO2 retention; 19 required mechanical ventilation due to increasing fatigue and worsening bronchospasm, having failed to respond to either inhaled or IV bronchodilator therapy. All patients were ventilated at slow rates (less than 12 min) and their airway pressure (Paw) was deliberately kept below 45 cmH2O, while accepting a PaCO2 in the 45-60 mmHg range, as long as the pH was compensated. Although two patients developed pneumothoraces while on positive pressure ventilation, these were resolved without incidents. Five patients who had mediastinal or subcutaneous air leaks prior to intubation did not develop pneumothoraces. Following the initiation of mechanical ventilation, IV beta-agonist therapy was increased in order to reverse the bronchospasm and reduce the duration of mechanical ventilation. Mean duration of intubation was 42 hours. Fourteen of the 19 patients were weaned and extubated within 48 hours. All patients survived without sequelae. We conclude that a degree of controlled "hypoventilation" by deliberately choosing Paw less than 45 cmH2O can be successfully used to ventilate children with severe status asthmaticus with a reduced rate of pressure-related complications.
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PMID:Efficacy, results, and complications of mechanical ventilation in children with status asthmaticus. 175 29

Using the recruitment threshold technique, we measured the CO2 responsiveness of the unloaded respiratory pump in 14 mechanically ventilated patients prior to weaning. The CO2 recruitment threshold (CO2RT) was compared with the arterial CO2 tension during unassisted breathing (CO2SB) and with the PaCO2 during mechanical ventilation (CO2MV) at machine settings determined by the primary physician. Based on these comparisons, we tested the hypotheses that (1) patients without weaning-induced respiratory distress (group 1) maintain CO2SB near CO2RT, (2) patients with weaning-induced respiratory distress (group 2) retain CO2SB above CO2RT, thereby manifesting incomplete load compensation, and (3) CO2MV is ventilator setting dependent and provides insufficient information about the ventilatory requirement during weaning. Respiratory distress was prospectively defined as sustained tachypnea (rate greater than or equal to 30) or intense dyspnea (Borg scale rating) and limited weaning in nine of 14 patients. The average CO2RT was 40 mm Hg in both groups. All patients in group 1 maintained CO2SB near CO2RT (p greater than 0.1). Seven of nine patients in group 2 retained CO2 by greater than or equal to 3 mm Hg above CO2RT (p less than 0.01). There was no significant difference between CO2MV and CO2SB in either group. We conclude that CO2RT provides a better reference of the adequacy of ventilatory load compensation during weather than CO2MV.
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PMID:The control of breathing during weaning from mechanical ventilation. 190 19

Six full-term newborn infants are described who suffered from severe adult respiratory distress syndrome (ARDS). The triggering event was intrauterine/perinatal asphyxia in five, and group B streptococcal (GBS) septicemia in three. All had severe respiratory distress/failure and were ventilated mechanically with high concentrations of inspired oxygen and positive end-expiratory pressure. Radiography of the chest showed dense bilateral consolidation with air bronchograms and reduced lung volume. Persistent pulmonary hypertension (PPH) was documented in all cases. The coincidence of ARDS and PPH rendered respiratory management extremely difficult. For this reason high-frequency ventilation was instituted in all patients in order to improve CO2 elimination and induce respiratory alkalosis. Acute complications of respiratory therapy were encountered in five patients (pneumothorax, pulmonary interstitial emphysema, pneumopericardium). Three infants died (irreversible septic shock, progressive severe hypoxemia, and sudden cardiac arrest) after 17, 80, and 175 h of life. Histologic examination of the lungs was possible in all fatal cases and revealed typical changes of acute to subacute stages of ARDS. Three infants survived, the mean time of mechanical respiratory support being 703 h. Two patients were still dependent on oxygen after 1 month of life, and all survivors had increased interstitial markings and increased lung volumes on their chest roentgenograms at this time.
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PMID:The paradox of adult respiratory distress syndrome in neonates. 200 41


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