Pneumothorax in the Respiratory Distress Syndrome: Incidence and Effect on Vital Signs, Blood Gases, and pH

PEDIATRICS ◽  
1976 ◽  
Vol 58 (2) ◽  
pp. 177-183
Author(s):  
Edward S. Ogata ◽  
George A. Gregory ◽  
Joseph A. Kitterman ◽  
Roderic H. Phibbs ◽  
William H. Tooley
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Vital Signs ◽  
Blood Gases ◽  
Statistical Technique ◽  
Assisted Ventilation ◽  
Arterial Blood ◽  
The Difference ◽  
Respiratory Assistance

We determined the incidence of pneumothorax in 295 infants (mean birthweight, 1,917 gm) with the respiratory distress syndrome (RDS) treated according to the same protocol. Fifty-five infants (mean birthweight, 1,594 gm) developed pneumothorax (incidence, 19%); incidence varied with severity of RDS and intensity of respiratory assistance. Pneumothorax occurred in 3.5% (2 of 58) of infants who received no assisted ventilation and in 11% (14 of 124) of infants who received continuous positive airway pressure (CPAP) as the only form of assisted ventilation; the difference between these two groups is not significant. Forty-nine infants initially treated with CPAP later required mechanical ventilation with positive end-expiratory pressure (PEEP). Pneumothorax occurred in 12 of the 49 (24%) and in 21 of 64 (33%) of those infants initially treated with PEEP; the incidence of pneumothorax for both these groups was significantly higher than for those treated with no assisted ventilation or CPAP only. To assess the value of frequent measurement of vital signs, blood gas tensions, and pH in the recognition of pneumothorax, we analyzed these variables by the cumulative sum statistical technique. We noted the following significant changes associated with pneumothorax: arterial blood pressure, heart rate, and respiratory rate decreased in 77% of cases; pulse pressure narrowed in 51% of cases; Po2 decreased in 17 of 20 cases in which ventilatory settings were constant for at least three hours prior to pneumothorax. However, pH and PCO2 showed no consistent changes. Frequent measurements of vital signs and Po2 aid in the early diagnosis of pneumothorax.

scholarly journals Effect of nebulized formoterol, ipratropium bromide, and furosemide in combination with fluticasone propionate on arterial blood gases of premature calves with respiratory distress syndrome

2020 ◽  
Vol 71 (1) ◽  
pp. 2011
Author(s):  
M. OK ◽  
R. YILDIZ ◽  
B. TRAŞ ◽  
N. BAŞPINAR ◽  
A. AKAR
Keyword(s):  
Fluticasone Propionate ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Partial Pressure ◽  
Ipratropium Bromide ◽  
Distress Syndrome ◽  
Standard Treatment ◽  
Blood Gases ◽  
Treatment Groups ◽  
Arterial Blood

The purpose of this study was to assess the clinical effect of nebulized formoterol (FM), ipratropium bromide (IB) and furosemide (FS) combined with fluticasone propionate (FP) on l ung function in premature calves with Respiratory Distress Syndrome (RDS). Thirty-six premature calves with RDS were randomly assigned to six different treatment groups (D1 to D6). All groups received the standard treatment, including oxygen and support treatment. Calves in D1 received only the standard treatment. The following combinations of nebulized drugs were used for the other groups: D2: FP, D3: FP+FM; D4: FP+IB; D5: FP+FS and D6: FP+IB+FM+FS. The treatment period (72 h) involved the application of FM (15 μg totally/12 h), IB (2 μg/kg/12 h), FS (1 mg/kg/12 h) and FP (15 μg/kg/12 h) for five minutes. A significant increase over time in blood pH, partial pressure of oxygen (PaO2), oxygen saturation (SatO2) and a decrease in partial pressure of carbon dioxide (PaCO2) and lactate were detected in all groups that received nebulized treatment; while in the D1, a significant change was observed only for PaCO2. Calves in D6 had the highest PaO2 and lowest PaCO2 values amongst all groups at the end of treatment. No statistical difference was observed between the Nebulization Groups (NG). Nebulized FM, IB and FS with FP combination in premature calves with RDS, in addition to the standard treatment showed a significant curative effect on lung function.

scholarly journals Early effects of ventilatory rescue therapies on systemic and cerebral oxygenation in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome: a prospective observational study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Chiara Robba ◽  
◽  
Lorenzo Ball ◽  
Denise Battaglini ◽  
Danilo Cardim ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Acute Respiratory Distress Syndrome ◽  
Observational Study ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Prospective Observational Study ◽  
Distress Syndrome ◽  
Cerebral Oxygenation ◽  
Arterial Blood ◽  
Early Effects

Abstract Background In COVID-19 patients with acute respiratory distress syndrome (ARDS), the effectiveness of ventilatory rescue strategies remains uncertain, with controversial efficacy on systemic oxygenation and no data available regarding cerebral oxygenation and hemodynamics. Methods This is a prospective observational study conducted at San Martino Policlinico Hospital, Genoa, Italy. We included adult COVID-19 patients who underwent at least one of the following rescue therapies: recruitment maneuvers (RMs), prone positioning (PP), inhaled nitric oxide (iNO), and extracorporeal carbon dioxide (CO2) removal (ECCO2R). Arterial blood gas values (oxygen saturation [SpO2], partial pressure of oxygen [PaO2] and of carbon dioxide [PaCO2]) and cerebral oxygenation (rSO2) were analyzed before (T0) and after (T1) the use of any of the aforementioned rescue therapies. The primary aim was to assess the early effects of different ventilatory rescue therapies on systemic and cerebral oxygenation. The secondary aim was to evaluate the correlation between systemic and cerebral oxygenation in COVID-19 patients. Results Forty-five rescue therapies were performed in 22 patients. The median [interquartile range] age of the population was 62 [57–69] years, and 18/22 [82%] were male. After RMs, no significant changes were observed in systemic PaO2 and PaCO2 values, but cerebral oxygenation decreased significantly (52 [51–54]% vs. 49 [47–50]%, p < 0.001). After PP, a significant increase was observed in PaO2 (from 62 [56–71] to 82 [76–87] mmHg, p = 0.005) and rSO2 (from 53 [52–54]% to 60 [59–64]%, p = 0.005). The use of iNO increased PaO2 (from 65 [67–73] to 72 [67–73] mmHg, p = 0.015) and rSO2 (from 53 [51–56]% to 57 [55–59]%, p = 0.007). The use of ECCO2R decreased PaO2 (from 75 [75–79] to 64 [60–70] mmHg, p = 0.009), with reduction of rSO2 values (59 [56–65]% vs. 56 [53–62]%, p = 0.002). In the whole population, a significant relationship was found between SpO2 and rSO2 (R = 0.62, p < 0.001) and between PaO2 and rSO2 (R0 0.54, p < 0.001). Conclusions Rescue therapies exert specific pathophysiological mechanisms, resulting in different effects on systemic and cerebral oxygenation in critically ill COVID-19 patients with ARDS. Cerebral and systemic oxygenation are correlated. The choice of rescue strategy to be adopted should take into account both lung and brain needs. Registration The study protocol was approved by the ethics review board (Comitato Etico Regione Liguria, protocol n. CER Liguria: 23/2020).

scholarly journals Effect of deep breathing exercises and incentive spirometry on respiratory distress scoring in second degree inhalational burn patients.

2019 ◽  
Vol 2 (1) ◽  
pp. 13-16
Author(s):  
Summiya Siddique Malik ◽  
Sadaf Saeed ◽  
Sumaira Kanwal
Keyword(s):  
Respiratory Distress ◽  
Vital Signs ◽  
Blood Gases ◽  
Sampling Technique ◽  
Control Group ◽  
Deep Breathing ◽  
Breathing Exercises ◽  
Arterial Blood ◽  
Experimental Group ◽  
Second Degree

Objective: Study was conducted for 6 months in PIMS Hospital Islamabad. Data was collected on self-structured Questionnaire, Respiratory distress scoring, Objective tools of Arterial blood gases and vital signs with signed consent. Methodology: The subjects were randomly allocated in experimental and control groups. Baseline data was collected and re-collected on Day 0 and Day 7 respectively and assessed using non-probability convenient sampling technique. Both groups were given standard medical and nursing care. Results: The experimental group was given single treatment regimen i.e. Deep breathing exercises (with 5-10 repetitions of each DBE being possible onto patient for 15-30 minutes twice daily). The control group was given 10-15 cycles of ISM with prior steam inhalation and nebulization with salbutamol for a period of 15-20 minutes for 35-45 minutes twice daily for a period of 07 days. Conclusion: The experimental group results show that deep breathing exercises are significantly effective in improving post burn complications like pneumonia in patients suffering from second degree inhalation burns.

Acute respiratory failure and acute respiratory distress syndrome

2018 ◽  
Author(s):  
Luciano Gattinon ◽  
Eleonora Carlesso
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Partial Pressure ◽  
Distress Syndrome ◽  
Gas Analysis ◽  
Chronic Obstructive ◽  
Low Oxygen ◽  
Arterial Blood

Respiratory failure (RF) is defined as the acute or chronic impairment of respiratory system function to maintain normal oxygen and CO2 values when breathing room air. ‘Oxygenation failure’ occurs when O2 partial pressure (PaO2) value is lower than the normal predicted values for age and altitude and may be due to ventilation/perfusion mismatch or low oxygen concentration in the inspired air. In contrast, ‘ventilatory failure’ primarily involves CO2 elimination, with arterial CO2 partial pressure (PaCO2) higher than 45 mmHg. The most common causes are exacerbation of chronic obstructive pulmonary disease (COPD), asthma, and neuromuscular fatigue, leading to dyspnoea, tachypnoea, tachycardia, use of accessory muscles of respiration, and altered consciousness. History and arterial blood gas analysis is the easiest way to assess the nature of acute RF and treatment should solve the baseline pathology. In severe cases mechanical ventilation is necessary as a ‘buying time’ therapy. The acute hypoxemic RF arising from widespread diffuse injury to the alveolar-capillary membrane is termed Acute Respiratory Distress Syndrome (ARDS), which is the clinical and radiographic manifestation of acute pulmonary inflammatory states.

Improvement in Oxygenation by Phenylephrine and Nitric Oxide in Patients with Adult Respiratory Distress Syndrome 

1997 ◽  
Vol 87 (1) ◽  
pp. 18-25 ◽  
Author(s):  
Elana B. Doering ◽  
C. William Hanson ◽  
Daniel J. Reily ◽  
Carol Marshall ◽  
Bryan E. Marshall
Keyword(s):  
Nitric Oxide ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Adult Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Hypoxic Pulmonary Vasoconstriction ◽  
Random Order ◽  
Pulmonary Vasoconstriction ◽  
Arterial Blood ◽  
Inhaled No

Background Inhaled nitric oxide (NO), a selective vasodilator, improves oxygenation in many patients with adult respiratory distress syndrome (ARDS). Vasoconstrictors may also improve oxygenation, possibly by enhancing hypoxic pulmonary vasoconstriction. This study compared the effects of phenylephrine, NO, and their combination in patients with ARDS. Methods Twelve patients with ARDS (PaO2/FIO2 &lt;le&gt; 180; Murray score &lt;me&gt; 2) were studied. Each patient received three treatments in random order: intravenous phenylephrine, 50-200 micrograms/min, titrated to a 20% increase in mean arterial blood pressure; inhaled NO, 40 ppm; and the combination (phenylephrine+NO). Hemodynamics and blood gas measurements were made during each treatment and at pre- and posttreatment baselines. Results All three treatments improved PaO2 overall. Six patients were "phenylephrine-responders" (delta PaO2 &gt; 10 mmHg), and six were "phenylephrine-nonresponders." In phenylephrine-responders, the effect of phenylephrine was comparable with that of NO (PaO2 from 105 +/- 14 to 132 +/- 14 mmHg with phenylephrine, and from 110 +/- 14 to 143 +/- 19 mmHg with NO), and the effect of phenylephrine+NO was greater than that of either treatment alone (PaO2 from 123 +/- 13 to 178 +/- 23 mmHg). In phenylephrine-nonresponders, phenylephrine did not affect PaO2, and the effect of phenylephrine+NO was not statistically different from that of NO alone (PaO2 from 82 +/- 12 to 138 +/- 28 mmHg with NO; from 84 +/- 12 to 127 +/- 23 mmHg with phenylephrine+NO). Data are mean +/- SEM. Conclusions Phenylephrine alone can improve PaO2 in patients with ARDS. In phenylephrine-responsive patients, phenylephrine augments the improvement in PaO2 seen with inhaled NO. These results may reflect selective enhancement of hypoxic pulmonary vasoconstriction by phenylephrine, which complements selective vasodilation by NO.

scholarly journals MDCT in ARDS: A single center experience

2016 ◽  
Vol 63 (2) ◽  
pp. 59-63
Author(s):  
Helena Maksimovic ◽  
Nikola Hajder ◽  
Vesna Bumbasirevic ◽  
Uros Bumbasirevic ◽  
Biljana Markovic ◽  
...  
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Objective Assessment ◽  
Conventional Radiography ◽  
Cellular Damage ◽  
Disease Evolution ◽  
Single Center Experience ◽  
Arterial Blood ◽  
Alveolar Capillary

Acute respiratory distress syndrome (ARDS) is a clinical condition first described by Ashbaugh et al in 1967 using the term ?adult respiratory distress syndrome?1. In order to establish a diagnosis of ARDS, radiological findings are necessary and they serve as one of the postulates. According to the latest definition, which was created by a panel of experts in 2011 in Berlin, thus termed the Berlin definition of ARDS, ARDS2 is a condition starting within 1 week of clinical insult with bilateral infiltrates detectable by chest imaging (either conventional radiography or multidetector computed tomography (MDCT) scan of lungs) and severe hypoxemia in the absence of evidence for cardiogenic pulmonary edema or fluid overload. It is necessary to explain the origin of edema, and to do that we need objective assessment (e.g., echocardiography) in order to exclude cardiogenic factors. Severity of ARDS is based on ratio between partial oxygen pressure in arterial blood and fraction of oxygen in the inspired air (PaO2 /FIO2) on 5 cm of continuous positive airway pressure (CPAP). The 3 categories are mild (PaO2/FIO2 200-300), moderate (PaO2/FIO2 100-200) and severe (PaO2/FIO2 =100). The definition itself says that in order to make a diagnosis we must do radiology imaging, although it does not say which one should be performed, the conventional radiography or MDCT. ARDS represents a stereotypic response to many different inciting insults and goes through a number of different phases, from alveolar capillary damage to lung resolution or a fibro-proliferative and fibrotic phase. The pulmonary epithelial and endothelial cellular damage is characterized by inflammation, apoptosis, necrosis and increased alveolar capillary permeability, which lead to development of alveolar edema. Purpose and role of radiographic methods is to assist in the visualization of above mentioned pathomorphological substrate. Because of the fact that sensitivity of conventional radiography is significantly lower than that of MDCT imaging, MDCT could be the primary method of choice in the initial diagnosis, but for the patient with ARDS it is most important that he has the best conditions concerning mechanical ventilation, which is very complicated to provide during the transportation of the patient from intensive care unit to MDCT diagnostic unit. As the disease evolves inside the lung area, some of the complications can be visualized only with MDCT. That is one of the main reasons MDCT is used for that period of disease evolution. Because of everything that is mentioned above, it is hard to decide whether and when MDCT scan should be performed.

scholarly journals Experience of Nursing and Pipeline Maintenance before and after Implantation ECMO in Patients with Acute Respiratory Distress Syndrome (A Case)

2021 ◽  
Vol 4 (1) ◽  
pp. 44
Author(s):  
Fang Xie ◽  
Jiarong Zhang ◽  
Ming Zhang
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Nursing Care ◽  
Active Treatment ◽  
Distress Syndrome ◽  
Vital Signs ◽  
Severe Pneumonia ◽  
Before And After ◽  
Post Implantation

Objective: experience in post-implantation care and pipeline maintenance in patients with acute respiratory distress syndrome. Methods:2020Admitted on 27 July1 Cases of severe pneumonia were transferred to severe ventilator on August 6 and to critical ECMO on August 10. Results: after active treatment, especially for the late stage of ECMO pipeline, the vital signs of the patients improved obviously and the condition gradually stabilized. Conclusion: The nursing care before and after the establishment of ECMO pipeline in patients with acute respiratory distress syndrome, the matters needing attention and the working experience after the establishment, It can provide a reference for the treatment of severe infectious diseases in the future.

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