Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0476273 (respiratory distress)
 19,632 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Noninvasive positive pressure ventilation (NPPV) has been proposed in COPD patients with acute on chronic respiratory failure (ACRF) in order to avoid endotracheal intubation and to improve immediate outcome, but long-term outcome of this therapeutic approach is still undefined. We evaluated short- and long-term (1 year) outcome of early administration of NPPV in 24 patients with ACRF due to exacerbated COPD (Group A) in comparison with 24 matched historical-control patients treated conventionally (Group B). Patients of Group A were initially treated with NPPV via nasal mask in the presence of pH < or = 7.32, and/or Pa,O2 < 7.98 kPa, and/or Pa,CO2 > 7.18 kPa, plus signs of respiratory distress. In-hospital survival rate was not significantly different in Group A vs Group B, but the patients treated with NPPV showed an earlier improvement in blood gases and a better pH and respiratory rate at discharge. Only 2 patients of Group A needed endotracheal intubation as compared with 9 of Group B. Hospital stay was significantly reduced in survivors of Group A vs Group B. Further severe relapses of ACRF in Group A were treated using NPPV. The number and length of further hospitalizations for pulmonary exacerbations were significantly higher in Group B compared with Group A. The survival rate at 12 months was significantly lower in Group B than in Group A (50% vs 71%). In conclusion, NPPV administration in patients with ACRF due to exacerbated COPD improves not only immediate but also long-term outcome.
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PMID:Noninvasive mechanical ventilation improves the immediate and long-term outcome of COPD patients with acute respiratory failure. 872 99

Fowler (Fowler, W.S., 1954, J. Appl. Physiol. 6:539-545) showed that rebreathing, despite worsening PCO2 and O2 saturation, relieved the distress of breathholding; he suggested a role for vagal input in the relief. We studied effects on respiratory sensation of breathholding and rebreathing in normals, patients with bilateral lung transplants (LT), who have a decrease in number of pulmonary stretch receptors (PSR), and heart transplant recipients (HT). Subjects held their breath until distress became intolerable, rebreathed various combinations of CO2 and O2, then performed another maximal breathhold. Respiratory distress was rated continuously (visual analog scale) by each subject. Both LT and HT had earlier onset of and more rapidly developing distress during breathholding, resulting in shorter breathhold times, than normals. Relief with rebreathing was neither as rapid nor as great in LT as in HT and normals. Our findings suggest that mechanisms that produce respiratory distress in HT and LT are similar, but differ from normals. However, reduction in distress on rebreathing is more rapid and greater in HT and normals than in LT. This is compatible with the loss during rebreathing of the inhibitory effect of PSR input on neural mechanisms that lead to respiratory distress.
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PMID:Relief of the 'air hunger' of breathholding. A role for pulmonary stretch receptors. 873 98

This study was conducted to assess the CO2-elimination efficiency of tracheal gas insufflation (TGI) in 20 patients with acute respiratory distress syndrome and to compare its efficacy during volume-controlled (VCV) and pressure-controlled ventilation (PCV). TGI was initially applied as an adjunct to VCV, with continuous flows (Vcath) of 4 and 6 L/min delivered through a catheter positioned 2 cm above the carina. Total effective tidal volume (VTeff) was held constant. The percent reductions in PaCO2 (% delta PaCO2) were 13.3 +/- 2.1 and 16.7 +/- 2.7% at Vcath 4 and 6 L/min, respectively, which correlated well with the percent reduction in the end-tidal PCO2 from baseline (% delta PETCO2) (r = 0.75, p < 0.001). An inverse relationship (r = -0.65, p < 0.001 and r = -0.59, p < 0.01 at Vcath 4 and 6 L/min, respectively) was found between the % delta PaCO2 and the baseline ratio of artery to PETCO2 difference to PaCO2, which was determined as the fraction of alveolar dead space (VDalv) relative to total alveolar ventilation. Twelve patients were subsequently switched to PCV combined with Vcath 6 L/min, which provided a % delta PaCO2 of 16.1 +/- 3.0% (p = NS versus 17.1 +/- 2.6% during VCV). These data suggest that in patients with ARDS the change in PETCO2 may be helpful in predicting the decrement in PaCO2 during TGI, and the existence of a high VDalv tends to limit its effectiveness. Further, the efficacy of TGI with VCV is equivalent to that with PCV.
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PMID:Efficacy of tracheal gas insufflation in acute respiratory distress syndrome with permissive hypercapnia. 881 May 94

Liquid ventilation with perfluorocarbon (PFC) has been considered to offer advantages over gas ventilation to respiratory distress syndrome patients. We developed a volume-controlled liquid ventilator with pressure-limit mode; inspiration is performed mechanically with an actuator under the preset limit of the intratracheal pressure (Paw); expiration is performed by gravity assistance. Oxygenation and CO2 removal of PFC are done with a membrane oxygenator. An endotracheal tube with a Paw monitor line was placed in 5 rabbits weighing 2.7 +/- 0.6 kg, and liquid ventilation was conducted with the condition that the upper and lower limits of Paw were 20 and -20 mm Hg, respectively. The best arterial pH and gas tension were examined. The averaged arterial pH and gas tension were examined. The averaged arterial pH. Pao2, Paco2, and Sao2 were 7.45 mm Hg, 369 mm Hg, 46.2 mm Hg, and 100% at the best values, respectively. Ventilatory conditions at the best values were as follows: ventilation rates, tidal volume peak Paw, average Paw, and trough Paw were 5-15 (11 +/- 4) times/min, 13.3-17.3 (15.6 +/- 1.4) ml/kg, 5-18 (12 +/- 5) mm Hg, -7-4 (-1 +/- 4) mm Hg, and -20(-)-6 (-13 +/- 5) mm Hg, respectively. Pressure-limit control of the system worked well, but in the initial 3 animals, fluorothrax, that is the leakage of PFC into thoracic cavity, was recognized at the Paw from 20 to 25 mm Hg after the upper pressure limit was raised to 25 mm Hg to improve Paco2. The fluorothrax seemed to be caused by excess end-expiratory residual volume. An expiratory control mechanism appears to be imperative for further improvement of our liquid ventilator.
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PMID:A volume-controlled liquid ventilator with pressure-limit mode: imperative expiratory control. 886 28

Capnocytophaga canimorsus, formerly designated Dysgonic fermenter 2 (DF-2) was first described in 1976; it is a commensal bacterium of dogs and cats saliva, which can be transmitted to man by bite (54% of cases), scratch (8.5%), or mere exposure to animals (27%). We present a review of the clinical and microbiological characteristics of the Capnocytophaga canimorsus infections and 12 cases of infection in France. Over 100 cases of human infections have been reported, mainly septicemia in patients with diminished defences, due to splenectomy (33%), alcohol abuse (24%), immunosuppression (5%). However 40% of septicemia occur in patients with no predisposing conditions. Other infections are less frequent: meningitis, endocarditis, arthritis, pleural and localized eye infections. These infections range from mild to fulminating disease, with shock, respiratory distress, disseminated intravascular coagulation. Dermatological lesions (macular or maculopapular rash, purpura) or gangrene are common. This fastidious Gram-negative bacterium grows slowly on chocolate agar or on heart infusion agar with 5% rabbit blood incubated in 5% CO2. In spite of a great susceptibility of bacteria to antibiotics, the mortality is of 30%. Because of the severity of these infections, taking into account this organism in the management of bites is necessary, especially in patients with predisposing factors.
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PMID:Capnocytophaga canimorsus infections in human: review of the literature and cases report. 890 16

Understanding the complex multisystem dysfunction in the infant with a congenital hernia of the posterolateral diaphragm is still evolving and has changed radically during the last decade. The reduction in lung mass, in conjunction with surfactant deficiency and diminished compliance, leads to initial deficiencies in oxygenation and carbon dioxide (CO2) removal. This may then be potentiated by an extremely reactive hypoplastic pulmonary arterial system. Treatment no longer is focused on the operative repair but rather on the components of the pathophysiological process that are potentially reversible. Thus, extracorporeal membrane oxygenation and delay of repair until resolution of pulmonary artery hypertension have become mainstays of therapy and are probably responsible for increasing the survival rate in the patient who presents early with respiratory distress from 50% to 65%. Still far from acceptable, these results are giving impetus to new approaches to therapy including drugs such as nitric oxide, fetal intervention including open repair, and lung transplantation.
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PMID:Congenital diaphragmatic hernia: an overview. 893 50

Complications may occur when nutritional support is administered either parenterally or enterally. Inappropriate nutritional formulas with high carbohydrate loads can precipitate respiratory failure in patients with compromised lung function, induce respiratory distress which manifests as dyspnea and tachypnea in an originally normal lung condition, produce hypercapnic acidosis in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) as well as patients recovering from acute respiratory distress syndrome (ARDS) without chronic lung disease, or result in difficult weaning. Hypercaloric mixed substrates administered either parenterally or enterally can also have profound impacts on gas exchange and energy expenditure. This report describes a patient who experienced exacerbation of respiratory distress and hypercapnic acidosis during recovery from septic ARDS as the result of a nutritionally-related increase in CO2 production. As carbohydrate calories were decreased, CO2 production diminished and the hypercapnia was resolved. The importance of indirect calorimetry cannot be overemphasized during tailoring of nutritional support for the critically ill patients.
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PMID:Hypercapnic respiratory acidosis precipitated by hypercaloric carbohydrate infusion in resolving septic acute respiratory distress syndrome: a case report. 903 53

Replacing gas in the lung with perfluorocarbon fluids (PFC) and periodically ventilating with a gas [partial liquid ventilation (PLV)] has been shown to improve oxygenation in models of respiratory distress syndrome. We hypothesized that the addition of PFC to healthy lungs would result in shunt, diffusion impairment, and increased ventilation-perfusion (VA/Q) heterogeneity. Previously, Mates et al. showed that O2 shunt and arterial-alveolar CO2 difference increased linearly with dose in piglets given graded intratracheal doses of PFC (10, 20, and 30 ml/kg followed by mechanical ventilation with 100% O2) (E.A. Mates, J. C. Jackson, J. Hildebrandt, W. E. Truog, T. A. Standaert, and M. P. Hlastala. In: Oxygen Transport to Tissue XVI, 1994, p. 427-435). Here we report VA/Q distribution in the same animals, showing a 50% increase in VA/Q heterogeneity during PLV independent of PFC dose. Ventilation heterogeneity was the major factor in this increase, and there was no significant change in dead space ventilation. We also report on five animals given a single 20 ml/kg dose of PFC and followed for 3 h. They showed an increase in shunt during PLV but no change in arterial-alveolar CO2 difference.
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PMID:Shunt and ventilation-perfusion distribution during partial liquid ventilation in healthy piglets. 907 85

To determine the mechanisms of acute respiratory distress and failure in patients with chronic obstructive pulmonary disease (COPD), we studied 17 ventilator-supported patients who failed a trial of spontaneous breathing and 14 patients who tolerated such a trial and were successfully extubated. Immediately before the weaning trials, maximal inspiratory pressure was not statistically different between the two groups (p = 0.48). On discontinuation of the ventilator, the failure group immediately developed rapid shallow breathing, and higher values of dynamic lung elastance (EdynL) (p < 0.01) and intrinsic positive end-expiratory pressure (PEEPi, p < 0.03) than did the success group. Between the onset and end of the trial, the failure group developed further increases in EdynL (p < 0.0001) and PEEPi (p < 0.0001), and increases in inspiratory resistance (p < 0.009) and inspiratory pressure-time product (PTP) (p < 0.0001). Partitioning of PTP at the end of the trial revealed a 111% increase in the PEEPi component, a 33% increase in the non-PEEPi elastic component, and a 42% increase in the resistive component (all p < 0.0001). Despite the increase in PTP, 13 of the failure patients developed an increase in PaCO2. The product of PTP and PaCO2, an index of inefficient CO2 clearance, was more than twice as high in the failure group than in the success group at the end of the trial (p < 0.0005). Thus, development of acute respiratory distress during a failed weaning attempt was due to worsening of pulmonary mechanics, which in conjunction with rapid shallow breathing led to inefficient clearance of CO2.
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PMID:Pathophysiologic basis of acute respiratory distress in patients who fail a trial of weaning from mechanical ventilation. 927 57

To assess the cardiorespiratory effects of a prolonged application of inverse ratio ventilation (IRV), we compared IRV (I/E = 2) with conventional ventilation (CV) (I/E = 0.5), applied for 6 h each in a randomized order, with constant tidal volume (VT) and total positive end-expiratory pressure (PEEP(tot)) in eight patients with acute respiratory distress syndrome (ARDS). After 1 h, IRV resulted in a lower peak inspiratory pressure (PIP) (28.2 +/- 1.5 versus 35.6 +/- 1.7 cm H2O, p < 0.05), an unchanged plateau pressure, and a higher mean airway pressure (MAP) (17.8 +/- 0.8 versus 15.6 +/- 0.5 cm H2O, p < 0.05) than CV. No significant difference in Pa(O2) and shunt fraction (QS/QT) was observed (83 +/- 7 mm Hg and 40 +/- 4% in CV versus 92 +/- 14 mm Hg and 35 +/- 3% in IRV, respectively). The Pa(CO2) was lower in IRV (48 +/- 3 versus 55 +/- 5 mm Hg, p < 0.05). Cardiac index (CI) and oxygen delivery (D(O2)) were lower in IRV (3.7 +/- 0.4 L/min/m2 and 500 +/- 61 ml/min/m2 versus 4.6 +/- 0.5 L/min/m2 and 617 +/- 80 ml/min/m2, respectively, p = 0.05 for both). Regardless of the considered parameter, no significant difference was observed between results after 1, 2, 4, and 6 h in each mode. We conclude that IRV at a ratio that results in a significant intrinsic PEEP does not improve Pa(O2), enhances CO2 elimination, decreases cardiac output (CO), and does not exert any time-dependent effect.
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PMID:Inverse ratio ventilation (I/E = 2/1) in acute respiratory distress syndrome: a six-hour controlled study. 915 69


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