Clinical efficacy of combinations of nebulised fluticasone, salbutamol and furosemide on lung function in premature calves with respiratory distress syndrome

Surfactant deficiency, poor development of the lung structure and fibrosis as a result of inflammation are thought to play an important role in the development of respiratory distress syndrome in premature calves. Nebulised steroid (fluticasone), bronchodilator (salbutamol) and diuretics (furosemide) can be used in combination alongside standard treatment procedures for premature calves, and might improve viability as observed in infants, foals and horses with pulmonary disorders. Twenty-five premature calves with respiratory distress syndrome were used in this study. Oxygen and supportive treatment were administered to all groups. The first group was used as a control group (Group 1). The nebulised drug combinations were as follows: Group 2: fluticasone + salbutamol, Group 3: salbutamol + furosemide, Group 4: fluticasone + furosemide and Group 5: fluticasone + salbutamol + furosemide. During the 72-h time period of the study, fluticasone (15 µg/kg/12 h), salbutamol (0.025 mg/kg/6 h) and furosemide (1 mg/kg/12h) were applied for 5 min. Arterial blood samples were collected from the auricular artery at 0 h and at 1, 24, 48 and 72 h for blood gas analysis. Significant (P < 0.05) increases in arterial partial oxygen, oxygen saturation and peripheral oxygen saturation and decreases in arterial partial carbon dioxide, lactate and respiration rate were observed in all the nebulised treatment groups, while a statistical difference was observed only for arterial partial carbon dioxide in control group. When comparing the treated groups with the control, it may be concluded that nebulised drugs are highly effective in the therapy of premature calves with respiratory distress syndrome, while the different nebulised groups exhibited similar efficacies.

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Weil’s disease with haemoptysis and acute respiratory distress syndrome

BMJ Case Reports ◽

10.1136/bcr-2019-229350 ◽

2019 ◽

Vol 12 (5) ◽

pp. e229350

Author(s):

Afroditi Roumpou ◽

Ioanna Papaioannou ◽

Christos Lampropoulos

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Blood Gas Analysis ◽

Liver Function Tests ◽

Respiratory Alkalosis ◽

Gas Analysis ◽

Arterial Blood Gas ◽

Arterial Blood

A 35-year-old male patient reached the emergency department after an episode of massive haemoptysis a few hours ago. Fever and dyspnea were mentioned to be present the last 5 days. His medical history included only malaria, successfully treated 2 years ago. Clinical examination revealed high fever, jaundice, cyanosis, tachypnea and bilateral rales on pulmonary auscultation. Laboratory investigation showed high erythrocyte sedimentation rate and C reactive protein, leucocytosis, anaemia, mild thrombocytopaenia, renal impairment, hyperbilirubinaemia and abnormal liver function tests; arterial blood gas analysis showed respiratory alkalosis with severe hypoxia. Thoracic X-ray revealed bilateral pulmonary infiltrates, whereas abdominal and heart ultrasound detected hepatomegaly and small pericardial infusion, respectively. The diagnosis of leptospirosis along with acute respiratory distress syndrome was confirmed by positive IgMLeptospiraantibodies. Empirical treatment with triple antibiotic therapy and corticosteroids was applied. The patient was discharged after 1 week, without any symptoms and with almost normal laboratory tests.

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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 ◽

10.1186/s13054-021-03537-1 ◽

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).

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Acute respiratory failure and acute respiratory distress syndrome

10.1093/med/9780199687039.003.0064_update_001 ◽

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.

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Pengaruh Prone positioning Terhadap Respiratory Rate dan Saturasi Oksigen Pada Bayi Gawat Napas (Respiratory Distress Syndrome ) di Ruang NICU RSUD Gunung Jati Cirebon

Malahayati Nursing Journal ◽

10.33024/mnj.v3i4.4541 ◽

2021 ◽

Vol 3 (4) ◽

pp. 500-506

Author(s):

Titin Supriatin ◽

Yani Nurhayani

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Oxygen Saturation ◽

Respiratory Rate ◽

Heat Loss ◽

Distress Syndrome ◽

Control Group ◽

Prone Positioning ◽

Post Test ◽

Equivalent Control

ABSTRACT: THE EFFECT OF PRONE POSITIONING ON RESPIRATORY RATE AND OXYGEN SATURATION IN INFANTS WITH RESPIRATORY DISTRESS SYNDROME IN NEONATUS INTENSIVE CARE UNIT AT GUNUNG JATI HOSPITAL CIREBON. Background: Respiratory Distress Syndrome (RDS), also known as respiratory distress syndrome, is a major threat to infants and children who are recovering from a serious illness. Currently, RDS is the leading cause of newborn death. Management of RDS includes improving oxygenation, prevention of infection, maintaining vascular pressure and cardiac output, adequate nutrition, positioning to improve functional residual capacity. The prone positioning for the baby is an energy-saving position because this position will reduce heat loss. This is because, in the prone positioning, the baby's feet are flexed, thereby reducing the body's metabolism resulting in a decrease in the amount of heat loss. Another reason is that in the prone position the baby's face touches the blanket or bed so that the baby's face is not exposed to air and allows a decrease in heat loss through the radiation process.Purpose: The purpose of this study was to determine the effect of the prone positioning on respiratory rate and oxygen saturation in respiratory distress syndrome (RDS) infants in NICU at Gunung Jati Hospital, Cirebon.Methode: The method of this research is a quasi-experimental study with a non-equivalent control group pre and post-test design. This study used a random sampling technique for 38 respondents. The analysis in this study uses paired t-test analysis.Result: The results showed that prone positioning can support the improvement of respiratory rate and oxygen saturation in infants with RDS.Conclusion: There are improvements in respiratory rate and oxygen saturation after prone positioning has been given. Keywords: Prone, Respiratory distress syndrome, Respiratory rate, oxygen saturation. INTISARI : PENGARUH PRONE POSITIONING TERHADAP RESPIRATORY RATE DAN SATURASI OKSIGEN PADA BAYI GAWAT NAPAS (RESPIRATORY DISTRESS SYNDROME ) DI RUANG NICU RSUD GUNUNG JATI CIREBON Latar belakang : Respiratory Distress syndrome (RDS) atau dikenal dengan sindrom gawat napas, merupakan ancaman utama pada bayi dan anak yang berada pada masa pemulihan dari penyakit berat. Saat ini RDS merupakan penyebab utama kematian bayi baru lahir. Penatalaksanaan RDS diantaranya adalah memperbaiki oksigenasi, pencegahan infeksi, mempertahankan tekanan vascular dan curah jantung, nutrisi yang adekuat, pemberian posisi untuk memperbaiki kapasitas residu fungsional. Posisi prone pada bayi merupakan posisi yang sangat menghemat energi, karena posisi ini akan menurunkan kehilangan panas. Hal ini disebabkan karena pada posisi prone, kaki bayi fleksi sehingga menurunkan metabolisme tubuh akibatnya terjadi penurunan jumlah kehilangan panas. Penyebab lain juga dikarenakan pada posisi prone wajah bayi menyentuh selimut atau tempat tidur sehingga wajah bayi tidak terpapar dengan udara dan memungkinkan terjadinya penurunan kehilangan panas melalui proses radiasiTujuan : penelitian ini adalah untuk megetahui pengaruh posisi prone terhadap respiratory rate dan saturasi oksigen pada bayi respiratory distress syndrome (RDS) di ruang NICU RSUD Gunung Jati Cirebon.Metode Penulisan : Penelitian ini merupakan penelitian kuasi experimental dengan desain pre and post test non equivalent control group. Penelitian ini menggunakan tehnik random sampling terhadap 38 responden. Analisis dalam penelitian ini menggunakan analisis paired t test.Hasil : Hasil penelitian menunjukkan bahwa posisi prone dapat mendukung perbaikan respiratory rate dan saturasi oksigen pada bayi dengan RDS.Kesimpulan : terdapat peningkatan respiratory rate dan saturasi oksigen setelah dilakukan intervensi posisi prone. Kata kunci: Prone, Respiratory distress syndrome, Respiratory rate, saturasi oksigen.

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Acute respiratory failure and acute respiratory distress syndrome

10.1093/med/9780199687039.003.0064 ◽

2015 ◽

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

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Cardiac biomarkers in premature calves with respiratory distress syndrome

Acta Veterinaria Hungarica ◽

10.1556/004.2016.004 ◽

2016 ◽

Vol 64 (1) ◽

pp. 38-46 ◽

Cited By ~ 3

Author(s):

Ugur Aydogdu ◽

Ramazan Yildiz ◽

Hasan Guzelbektes ◽

Alparslan Coskun ◽

Ismail Sen

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Troponin I ◽

Troponin T ◽

Venous Blood ◽

Gas Analysis ◽

Cardiac Biomarkers ◽

Control Group ◽

Creatine Kinase Mb

The aim of this study was to determine the clinical relevance of cardiac biomarkers [troponin I and T, creatine kinase-MB fraction (CK-MB) and lactate dehydrogenase (LDH)] in premature calves with respiratory distress syndrome. Seventy premature calves were admitted to the clinic within 24 h after birth. Respiratory distress syndrome was diagnosed in premature calves by clinical examination and venous blood gas analysis. Ten healthy calves, aged 5 days, were used as control. Cardiac troponin I and T were analysed using ELISA and ELFA, respectively. Serum CK-MB and LDH were also analysed in an automatic analyser. The calves had low venous pH, pO2, O2 saturation and high pCO2 values consistent with dyspnoea, hypoxaemia, and inadequate oxygen delivery. Mean serum troponin I, troponin T, CK-MB and LDH levels were increased in the premature calves compared to the control group. In conclusion, the results in this study demonstrated that serum CK-MB, troponin I and troponin T concentrations could be used for evaluating myocardial injury in premature calves with respiratory distress syndrome.

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Pulmonary ultrasound and pulse oximetry versus chest radiography and arterial blood gas analysis for the diagnosis of acute respiratory distress syndrome: a pilot study

Critical Care ◽

10.1186/s13054-015-0995-5 ◽

2015 ◽

Vol 19 (1) ◽

Cited By ~ 24

Author(s):

Cameron M. Bass ◽

Dana R. Sajed ◽

Adeyinka A. Adedipe ◽

T. Eoin West

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Pilot Study ◽

Respiratory Distress Syndrome ◽

Distress Syndrome ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Arterial Blood Gas Analysis

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Cerebrovascular autoregulation and arterial carbon dioxide in patients with acute respiratory distress syndrome: a prospective observational cohort study

Annals of Intensive Care ◽

10.1186/s13613-021-00831-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ursula Kahl ◽

Yuanyuan Yu ◽

Axel Nierhaus ◽

Daniel Frings ◽

Barbara Sensen ◽

...

Keyword(s):

Carbon Dioxide ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Acute Phase ◽

Cerebral Autoregulation ◽

Distress Syndrome ◽

Multivariable Analysis ◽

Cerebrovascular Autoregulation ◽

Arterial Blood

Abstract Background Early hypercapnia is common in patients with acute respiratory distress syndrome (ARDS) and is associated with increased mortality. Fluctuations of carbon dioxide have been associated with adverse neurological outcome in patients with severe respiratory failure requiring extracorporeal organ support. The aim of this study was to investigate whether early hypercapnia is associated with impaired cerebrovascular autoregulation during the acute phase of ARDS. Methods Between December 2018 and November 2019, patients who fulfilled the Berlin criteria for ARDS, were enrolled. Patients with a history of central nervous system disorders, cerebrovascular disease, chronic hypercapnia, or a life expectancy of less than 24 h were excluded from study participation. During the acute phase of ARDS, cerebrovascular autoregulation was measured over two time periods for at least 60 min. Based on the values of mean arterial blood pressure and near-infrared spectroscopy, a cerebral autoregulation index (COx) was calculated. The time with impaired cerebral autoregulation was calculated for each measurement and was compared between patients with and without early hypercapnia [defined as an arterial partial pressure of carbon dioxide (PaCO2) ≥ 50 mmHg with a corresponding arterial pH < 7.35 within the first 24 h of ARDS diagnosis]. Results Of 66 patients included, 117 monitoring episodes were available. The mean age of the study population was 58.5 ± 16 years. 10 patients (15.2%) had mild, 28 (42.4%) moderate, and 28 (42.4%) severe ARDS. Nineteen patients (28.8%) required extracorporeal membrane oxygenation. Early hypercapnia was present in 39 patients (59.1%). Multivariable analysis did not show a significant association between early hypercapnia and impaired cerebrovascular autoregulation (B = 0.023 [95% CI − 0.054; 0.100], p = 0.556). Hypocapnia during the monitoring period was significantly associated with impaired cerebrovascular autoregulation [B = 0.155 (95% CI 0.014; 0.296), p = 0.032]. Conclusion Our results suggest that moderate permissive hypercapnia during the acute phase of ARDS has no adverse effect on cerebrovascular autoregulation and may be tolerated to a certain extent to achieve low tidal volumes. In contrast, episodes of hypocapnia may compromise cerebral blood flow regulation. Trial registration ClinicalTrials.gov; registration number: NCT03949738; date of registration: May 14, 2019

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Predict respiratory distress syndrome by umbilical cord blood gas analysis in newborns with reassuring Apgar score

Italian Journal of Pediatrics ◽

10.1186/s13052-020-0786-8 ◽

2020 ◽

Vol 46 (1) ◽

Author(s):

Giuseppe De Bernardo ◽

Rita De Santis ◽

Maurizio Giordano ◽

Desiree Sordino ◽

Giuseppe Buonocore ◽

...

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Apgar Score ◽

Distress Syndrome ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas

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Validation of transcutaneous carbon dioxide monitoring using an artificial lung during adult pulsatile cardiopulmonary bypass

The International Journal of Artificial Organs ◽

10.1177/0391398820987855 ◽

2021 ◽

pp. 039139882098785

Author(s):

Lawrence Garrison ◽

Jeffrey B Riley ◽

Steve Wysocki ◽

Jennifer Souai ◽

Hali Julick

Keyword(s):

Carbon Dioxide ◽

Cardiopulmonary Bypass ◽

Gold Standard ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Artificial Lung ◽

Blood Gas ◽

Median Difference ◽

Transcutaneous Carbon Dioxide ◽

Arterial Blood

Measurements of transcutaneous carbon dioxide (tcCO2) have been used in multiple venues, such as during procedures utilizing jet ventilation, hyperbaric oxygen therapy, as well as both the adult and neo-natal ICUs. However, tcCO2 measurements have not been validated under conditions which utilize an artificial lung, such cardiopulmonary bypass (CPB). The purpose of this study was to (1) validate the use of tcCO2 using an artificial lung during CPB and (2) identify a location for the sensor that would optimize estimation of PaCO2 when compared to the gold standard of blood gas analysis. tcCO2 measurements ( N = 185) were collected every 30 min during 54 pulsatile CPB procedures. The agreement/differences between the tcCO2 and the PaCO2 were compared by three sensor locations. Compared to the earlobe or the forehead, the submandibular PtcCO2 values agreed best with the PaCO2 and with a median difference of –.03 mmHg (IQR = 5.4, p < 0.001). The small median difference and acceptable IQR support the validity of the tcCO2 measurement. The multiple linear regression model for predicting the agreement between the submandibular tcCO2 and PaCO2 included the SvO2, the oxygenator gas to blood flow ratio, and the native perfusion index ( R2 = 0.699, df = 1, 60; F = 19.1, p < 0.001). Our experience in utilizing tcCO2 during CPB has demonstrated accuracy in estimating PaCO2 when compared to the gold standard arterial blood gas analysis, even during CO2 flooding of the surgical field.

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