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

The high carbohydrate load of total parenteral nutrition (TPN) caused a 67% increase in CO2 production which precipitated respiratory distress in the 59-year-old man reported on herein. TPN given inappropriately can serve as a physiological stress rather than nutritional support.
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PMID:Respiratory distress secondary to a high carbohydrate load: a case report. 676 47

Four men, exposed to the pressure equivalent of 1,200 ft of seawater (37 ATA) for 6 days in a CO2-free, normoxic helium-oxygen environment (Predictive Studies III-1971, Aviation Space Environ. Med. 4: 843-855, 1977), had no evident respiratory distress at work, at rest, or asleep. Ventilatory responses of two men to CO2 were measured in 20-min acute exposures to mixtures of oxygen (173 Torr) with nitrogen, crude neon, and helium over a gas density range of 0.4-22 g/l and a pressure range of 1-37 ATA during stepwise compression of 37 ATA. Analysis of delta V/delta PACO2 as functions of pressure, of density, and of density-to-viscosity ratios shows that increased gas density, but not nitrogen narcosis, is associated with gross diminution of the ventilatory response to CO2. A small ventilatory response to CO2 is predicted for liquid breathing when viscosity is included as a parameter in the analysis. Other findings associated with increased gas densities and progressive elevation of inspired CO2 concentration are disruption of the normal patterns of tidal volume and frequency of breathing and reduction in the range of linear respiratory response to CO2.
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PMID:Human respiratory control at high ambient pressures and inspired gas densities. 676 2

High glucose intakes given during administration of total parenteral nutrition (TPN) have been demonstrated to increase CO2 production. The workload imposed by the high CO2 production may precipitate respiratory distress in patients with compromised pulmonary function. Changes in CO2 production and O2 consumption induced by TPN using either glucose as the entire source of non-protein calories, or fat emulsions as 50 per cent of the non-protein calories, have been analyzed either in patients with chronic nutritional depletion or in acutely ill patients secondary to injury and infection. In patients with chronic nutritional depletion, shifting from the lipid to the glucose system caused a 20 per cent (P less than 0.025) increase in CO2 production which resulted in a 26 per cent increase in minute ventilation (P less than 0.01). In the acutely ill patients receiving the glucose system, CO2 production was significantly higher than in those receiving the lipid system (179 vs. 147 ml.min-1.m-2; P less than 0.01. Fat emulsions can serve as a source of non-protein calories and are associated with lesser degrees of CO2 production than isocaloric amounts of glucose.
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PMID:Nutrition for the patient with respiratory failure: glucose vs. fat. 678 8

The interaction of lung mechanics, peripheral lung reflexes and chemosensitivity of the respiratory center were studied in over 80 newborns. Healthy newborns (gestational age between 30 and 41 weeks) and newborns with respiratory distress syndrome (RDS) (gestational age between 29 and 40 weeks) were studied on the first day of life. Spontaneously breathing newborns were examined using the airway occlusion technique (AOT), and intubated babies using the injection technique (IT) to measure the compliance of the respiratory system (Crs), the strength of the inspiration inhibiting reflex (IIR) and inspiratory time during airway occlusion (Ti occ), and index of chemosensitivity of the respiratory center. Crs in healthy newborns increased only slightly but statistically significant (p less than 0.001) with gestational age. Crs of newborns with RDS had an overwhelming influence on their prognosis. Newborns with Crs of less than or equal to 1 developed respiratory failure and needed ventilatory support. Newborns with a Crs less than or equal to 0.5 died despite respiratory therapy. The activity of the peripheral vagally mediated reflex system also depended on the Crs. Our results indicate that the decrease in reflex activity with gestational age is not brought about by neurologic maturation but is caused by the increasing Crs. We conclude that the peripheral vagally mediated reflexes remain the same throughout life, just the boundary condition Crs, which is given by the lung mechanics, is different for premature or mature newborns and changes with age. The chemosensitivity of the respiratory center for CO2 was characterized by the inspiratory time after an expiratory occlusion (Ti occ) which is not influenced by lung mechanics. Ti occ correlated significantly with pCO2. The relation between Ti occ and pCO2 was similar for premature and mature, healthy and respiratory ill newborns. Consequently, chemosensitivity, expressed as the ratio of Ti occ and pCO2, is independent of gestational age.
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PMID:[Respiratory mechanics and respiratory regulation in healthy and respiratory-diseased newborn infants of different gestational ages]. 680 40

The use of long-term endotracheal intubation in the treatment of respiratory distress syndrome in the newborn has seen an increase in the number of cases of acquired subglottic stenosis. Multiple methods of correction have been advocated in conjunction with the use of antibiotics, corticosteroids, and indwelling stents. An animal experiment utilizing 64 dogs was undertaken in an effort to devise an endoscopic procedure using the CO2 laser which might be successfully employed in the human patient. An attempt was also made to study the efficacy of antibiotics, corticosteroids, soft stents and rigid stents. Animals were divided into multiple groups, and their larynges were studied grossly and histologically some weeks after therapy was completed. Analysis of the results was undertaken, and the method with the best outcome was then employed in the human portion of the study. Twenty-four human patients, 12 with severe stenosis and 12 with partial stenosis were evaluated, and their outcome is reported.
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PMID:An experimental model for the endoscopic correction of subglottic stenosis with clinical applications. 689 95

Sixty patients with laryngocele were diagnosed in the last seven years: 25 of them without previous laryngeal pathology (group A) and the rest 35 with laryngeal or pharyngeal cancer (group B). The laryngocele was unilateral in the majority of the 25 patients of group A (68%). The internal laryngoceles were the most common type (63%). The initial symptom was hoarseness in 56% of these patients and 20% developed, in their evolution, an acute respiratory distress. The diagnosis was clinical in 16 patients and radiological in the rest. Endoscopically marsupialization with laser-CO2 was performed to remove internal laryngoceles. The mixed and external laryngoceles were completely removed via an external cervical approach without the need to perform any thyrotomy. The diagnosis was radiological by CT in the 35 patients of the group B. In 30 of them the CT was performed to evaluate the local extension of the laryngeal or pharyngeal cancer before its treatment. Supraglottic carcinoma was the most common laryngeal tumor (50%). The anatomic relationship between laryngocele and laryngeal cancer was ipsilateral to each other only in 50% of the patients. In the other 5 patients, no laryngocele was found in the radiological study previous to the treatment of the laryngeal or pharyngeal cancer. The diagnosis was made after chemotherapy and/or radiotherapy treatment.
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PMID:[Laryngocele: clinical and therapeutic study of 60 cases]. 754 53

Percutaneous endoscopic gastrostomy (PEG) is the procedure of choice in the nutritional management of patients requiring gastrostomies. Laparoscopic gastrostomy is usually performed when PEG is contraindicated, for example, in patients with esophageal strictures, large gastric tumors, or a history of multiple abdominal surgery. We report herein a case of gasless laparoscopic gastrostomy performed for carcinoma associated with a severe respiratory distress syndrome in a malnourished patient with a tight esophageal stricture. The gasless technique uses the Laparolift System (Laparolift, Origin Medsystem, Inc.), a device composed of a fan-shaped retractor and a mechanical lifting arm that produces an abdominal wall distention resembling a truncated pyramid. Gasless laparoscopy was a safe alternative approach to CO2 pneumoperitoneum in this patient.
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PMID:Gasless laparoscopic gastrostomy. 757 78

To assess whether pulmonary vagal afferents affect the duration of breathholding, the associated respiratory distress and their dependence on lung volume, we studied seven heart-lung transplant (HLT) patients with chronic pulmonary denervation and seven matched control subjects. Voluntary breathholds were performed at 20% and 80% vital capacity (VC) after rebreathing a 7% CO2-93% O2 gas mixture. Time to breakpoint, oxygen saturation, and end-tidal PCO2 were measured. All subjects were questioned on their sensations during breathholding; in addition, quantitative assessment of the sensations was obtained using a visual analog scale (VAS) in the seven control subjects and four HLT subjects. Breathholding time was comparable in both groups at each lung volume but was invariably shorter (p < 0.0005) at 20% VC (mean +/- SD; HLT versus control subjects: 68 +/- 29 versus 79 +/- 29 s) than at 80% VC (corresponding values: 92 +/- 35 versus 103 +/- 30 s). Similar results were obtained after anesthesia of intact tracheal and upper airway receptors in five HLT subjects. Six subjects from each group spontaneously reported air hunger and found it easier to perform breathholding at 80% than at 20% VC. The VAS ratings generally showed a maximum score at breakpoint, which implies that the distress increased more rapidly at low than at high lung volume. We conclude that in the absence of vagal afferent innervation from the lungs: (1) the air hunger form of dyspnea is maintained; (2) the duration of breathholding is not substantially modified; and (3) breathholding time and sensations still vary as a function of lung volume.
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PMID:Regulation of breathholding time and sensation after heart-lung transplantation. 766 76

Extracorporeal life support (ECLS) is a recognized treatment for neonatal respiratory distress unresponsive to other forms of therapy. Variations of this technique are being developed in an effort to extend its applicability and safety. Extracorporeal CO2 removal (ECCO2R) is one such modification that requires blood flows of 20% to 50% of cardiac output and therefore lends itself to percutaneous venous cannulation. The authors evaluated ECCO2R in conjunction with low-frequency ventilation, using a lung lavage-induced model of respiratory failure in rabbits. Six rabbits were lavaged an average of 9 times with 15 mL/kg Plasma-Lyte A at 37 degrees C via an endotracheal tube. Incremental ventilatory changes were made during lavage, to an FIO2 of 1.0, rate of 80, peak inspiratory pressure (PIP) of 37 cm H2O, and positive end-expiratory pressure (PEEP) of 4 cm H2O. Arterial blood gas values of PaO2 < 40 mm Hg and PaCO2 > 60 mm Hg resulted, meeting our criteria for respiratory failure. The rabbits were placed on veno-venous ECCO2R using a 0.8-m2 hollow fiber oxygenator and a commercially available double-lumen dialysis catheter. Blood flows of 10 to 20 mL/kg/min were used to manage CO2 removal. A low-frequency ventilation technique was employed using an FIO2 of 1.0 and a rate of 5 breaths per minute. PEEP was increased incrementally to maintain the PaO2 above 80 mm Hg. After initiation of ECCO2R, the arterial PaO2 increased to 165 +/- 109 mm Hg, with PEEP above 15 cm H2O, and PaCO2 decreased to 37 +/- 5 mm Hg, with a bypass flow rate of 15 mL/kg/min.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Extracorporeal CO2 removal in a lung lavage model of respiratory failure. 796 19

We describe the beneficial effects of an intravenous oxygenator (IVOX) on ventilatory pressure requirement, and also several severe complications related to its use in a young trauma victim developing severe acute respiratory distress syndrome (ARDS). In this patient, adequate systemic oxygenation could not be maintained despite the use of fractional inspired oxygen of 1.0, high level positive end-expiratory pressure (PEEP), and nitric oxide inhalation (30 ppm). The introduction of an intravenous oxygenator improved arterial oxygenation and CO2 elimination, allowing a decrease in minute ventilation and airway pressure. However, hepatic cytolysis, acute renal dysfunction and iliac vein thrombosis developed concomitantly, in spite of full anticoagulation with heparin. These complications resolved rapidly after removal of the IVOX device and the patient made a good recovery.
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PMID:IVOX in ARDS: respiratory effects and serious complications. 800 67


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