Cardiopulmonary abnormalities in severe acute respiratory failure

Katz, Robert; Pollack, Murray M.; Spady, Donald W.

doi:10.1016/s0022-3476(84)81095-1

Cited by 37 publications

(12 citation statements)

References 35 publications

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“…11,15,25 However, the most striking differences between our data and most previous studies were mortality rates of 18% and 14% for ALI and ARDS, respectively. These figures are considerably lower than those in many previous reports (Table 3 and Fig 1) 10,[12][13][14][15][16][17][18][19][20][21][22][23][24]38 but are quite consistent with findings from 3 pediatric studies published after 2000, which presented a weighted average mortality rate of 23%. [25][26][27] Our findings differ significantly from those of Erickson et al, 11 who recently reported a pediatric ALI mortality rate of 35%.…”

Section: Discussionsupporting

confidence: 86%

“…9 Overall, those publications estimated that ϳ1% to ϳ4% of PICU patients (range: 0.4%-9.8%) develop pediatric ALI/ARDS. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Two population-based studies that used physician surveys for case identification have been published. An incidence of ARDS in Germany of 3.4 cases per 100 000 personyears was reported.…”

mentioning

confidence: 99%

“…28 More recently, a prospective, multicenter, observational study from Australia and New Zealand noted a population incidence of 2.95 cases per 100 000 personyears. 11 Reported pediatric ALI mortality rates ranged from 19% to 90%, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] with lower mortality rates in morerecent studies. Furthermore, newer reports suggested that ALI mortality rates may be considerably lower for children than for adults.…”

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confidence: 99%

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Incidence and Outcomes of Pediatric Acute Lung Injury

et al. 2009

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Section: Discussionsupporting

confidence: 86%

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confidence: 99%

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confidence: 99%

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Incidence and Outcomes of Pediatric Acute Lung Injury

et al. 2009

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“…In contrast, animals treated with nebulized saline exhibited no significant improvement in oxygenation. The oxygenation effects noted with delivery of nebulized DMAEP/NO were similar to those observed in both animals and human subjects given continuously inhaled NO gas (10,16,(32)(33)(34). The improvement in oxygenation in the present study was probably due to improvements in intrapulmonary shunt.…”

Section: Discussionsupporting

confidence: 82%

“…The mortality rate in children with diagnosed ARDS ranges from 35 to 90% (6)(7)(8). Pulmonary hypertension is often present during the course of ARDS, and when persistent is associated with a poor prognosis (9,10). Systemic intravenous vasodilators such as nitroglycerin, nitroprusside, and prostaglandin E 1 have been used to treat pulmonary hypertension, but their effectiveness is limited because they cause systemic hypotension and ventilation/perfusion mismatch (11)(12)(13).…”

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confidence: 99%

Aerosolized Soluble Nitric Oxide Donor Improves Oxygenation and Pulmonary Hypertension in Acute Lung Injury

Jacobs

Brilli

Ballard

et al. 1998

Am J Respir Crit Care Med

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Acute respiratory distress syndrome (ARDS) is a major cause of morbidity and mortality in critically ill patients. The associated ventilation/perfusion mismatch and pulmonary hypertension are amenable to treatment with inhaled nitric oxide (NO) gas. Compounds formed by reacting NO with various nucleophiles (NONOates) release NO spontaneously and induce vasodilation. Intratracheally administered NONOates result in selective reduction in pulmonary hypertension. We hypothesized that a nebulized NONOate would improve oxygenation and reduce pulmonary vascular resistance in oleic acid-induced acute lung injury and pulmonary hypertension. Pigs underwent catheterization of the pulmonary artery, left atrium, and right atrium, and a flow probe was positioned around the pulmonary artery. Acute lung injury and pulmonary hypertension were induced with intravenous oleic acid. Animals were randomly assigned to receive either nebulized saline or the NONOate 2-(dimethylamino)ethylputreanine/NO (DMAEP/NO). Hemodynamic, gas exchange, pulmonary function, methemoglobin, and nitrite/nitrate measurements were obtained for 60 min. Animals in the DMAEP/NO group had improvement in PaO2 as compared with control animals (from 139 +/- 19 mm Hg to 180 +/- 19 mm Hg in the DMAEP/NO group [n = 6]; and from 144 +/- 6 mm Hg to 150 +/- 9 mm Hg in the saline group [n = 6], p < 0.05). After aerosol treatment, animals in the DMAEP/NO group had a greater reduction in pulmonary vascular resistance index (PVRI) than did control animals (from 81 +/- 17 dyne. s/cm5/kg to 34 +/- 8 dyne. s/cm5/kg; and from 104 +/- 16 dyne. s/cm5/kg to 64 +/- 11 dyne. sec/cm5/ kg in the saline group at 60 min, p < 0.05). There were no differences between the groups in systemic vascular resistance index (SVRI), cardiac index (CI), methemoglobin, nitrite/nitrate, or lung pathology scores. We conclude that DMAEP/NO improves oxygenation and has selective pulmonary vasodilating properties without causing significant systemic toxicity in this porcine model of acute lung injury.

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Early elevations in B‐type natriuretic peptide levels are associated with poor clinical outcomes in pediatric acute lung injury

Reel

Oishi

Hsu

et al. 2009

Pediatric Pulmonology

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Summary Objectives To determine B-type natriuretic peptide (BNP) levels in infants and children with acute lung injury (ALI), and to investigate associations between BNP levels and clinical outcome. Design Prospective observational study. Subjects After informed consent, plasma was collected from 48 pediatric patients on day 1 of ALI. Methodology Plasma BNP levels were measured by immunoassay on day 1 of ALI in 48 pediatric patients. Associations between BNP levels and outcome were determined. Results The mean PaO2/FiO2 at the onset of ALI was 155 (±74) and BNP values ranged from 5 to 2,060 pg/ml with a mean of 109 (±311). BNP levels were inversely correlated with ventilator-free days (Spearman rho −0.30, P =0.04), and positively correlated with exhaled tidal volume (Spearman rho 0.44, P =0.02). BNP levels were higher in patients receiving inotropic support (n =12) than patients not receiving inotropic support (n =33, P =0.02). BNP levels were correlated with PRISM III scores (Spearman rho 0.55, P <0.001) and PELOD scores (Spearman rho 0.4, P =0.006). Mortality for the cohort was 15%. BNP levels were higher in non-survivors (n =7) than survivors (n =41, P =0.055). Conclusions BNP levels are elevated in children with ALI/ARDS early in the disease course, and increased levels are associated with worse clinical outcome.

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Cardiopulmonary abnormalities in severe acute respiratory failure

Cited by 37 publications

References 35 publications

Incidence and Outcomes of Pediatric Acute Lung Injury

Incidence and Outcomes of Pediatric Acute Lung Injury

Aerosolized Soluble Nitric Oxide Donor Improves Oxygenation and Pulmonary Hypertension in Acute Lung Injury

Early elevations in B‐type natriuretic peptide levels are associated with poor clinical outcomes in pediatric acute lung injury

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