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[Non cardiogenic pulmonary edema (author's transl)].

Non cardiogenic pulmonary edema is caused by an increase of alveolocapillary permeability, due to different etiologies: fat embolism, multiple trauma, septic shock, influenza pneumonia, aspiration syndrome... Chest radiographs exhibit interstitial and/or alveolar pattern, severity of injury is assessed by the magnitude of intra-pulmonary shunting. Pulmonary wedge pressure is normal, and increased pulmonary vascular resistance is sometimes evidence in prolonged evolutions, especially in fatal cases. Treatment consists in the suppression of hypervolemia, and ventilation with positive and expiratory pressure (PEEP). Extra-corporeal membrane lung oxygenation remains since now rather unsuccessful.

Capillary Permeability↗

Pneumothorax and pneumomediastinum in infants with idiopathic respiratory distress syndrome receiving continuous positive airway pressure.

A review of infants with idiopathic respiratory distress syndrome developing pneumomediastinum and pneumothorax reveals (1) an incidence of 20% in patients receiving CPAP with an 11% incidence in comparable infants not receiving this mode of therapy; (2) in the CPAP-treated group the occurrence was at a stage in the illness when the inspired oxygen concentration was being lowered and when ventilation was stable; (3) the inspired oxygen concentration in the CPAP group at the time of the PM and/or PT was 52% (plus or minus S.D. 15%) at a mean age of 33 hours (plus or minus S.D. 23 hr). These observations suggest that distending airway pressure creates excessive alveolar distention as an underlying mechanism of the air leak. It is recommended that distending airway pressure be lowered prior to achieving an inspried oxygen concentration of 60%. A controlled study is in progress to delineate the optimum distending airway pressures at specific inspired oxygen concentrations in order to reduce the incidence of alveolar rupture to a minimum.

Birth Weight↗

Light- and electron microscopic investigations of pulmonary tissue after high-frequency positive-pressure ventilation (HFPPV).

Narcotisized dogs were artificially ventilated for periods of two to five hours with HFPPV. During this time the blood gases, pH and bases were controlled. In spite of sufficient oxygenation and CO2-elimination, a metabolic acidosis developed which could not be fully compensated by the addition of buffer solutions. In light and electron microscopy these lungs did not differ significantly from control lungs. Haemorrhages or atelectases were never observed. Type I cells as well as Type II cells in the alveoli are unchanged, i.e. the Type II cells were not depleted but contained numerous typical lamellar bodies with a diameter of 0.4-1 mu. The blood gas barrier was not widened and was ca. 3000 A wide. The alveolar surface was coated by an often fragmented electron-dense film (monolayer of the surfactant).

Acid-Base Equilibrium↗

Cardiopulmonary effects of positive end-expiratory pressure in anesthetized horses.

The cardiopulmonary effects of 0, 5, 10, and 15 cm of H2O positive end-expiratory pressures (PEEP) were determined in anesthetized, spontaneously breathing horses, using a 4 by 4 Latin-square design with one repetition. Cardiac output, alveolar-arterial oxygen tension difference, alveolar ventilation, dead space/tidal volume ratio, and carbon dioxide elimination were not significantly altered by the procedure. As PEEP was increased, alveolar and arterial oxygen tensions, respiratory exchange ratio, and pH decreased, whereas arterial carbon dioxide tension and oxygen consumption increased. These results indicate PEEP is contraindicated in laterally recumbent spontaneously ventilating anesthetized horses breathing air, because it causes alveolar hypoventilation and does not improve pulmonary gas exchange.

Anesthesia, Intravenous↗

Induced hypotension for orthognathic surgery.

Achieving satisfactory hemostasis during orthognathic surgery may be difficult because of the extensive vascularity of facial structures. Hypotensive anesthetic techniques provide clear operative fields by altering regional tissue perfusion through the use of systemic vasodilators, ganglionic blocking agents, and positioning of the patient. Thorough monitoring during surgery, careful selection of patients, and close communication between the surgeon and anesthesiologist permit safe anesthesia, can decrease operating time, and usually obviate the need for transfusions.

Adult↗

[Effect of chest physiotherapy on pO2 and pCO2 in premature and mature babies with respiratory distress syndrome (author's transl)].

pH, pCO2, pO2 and where possible DAaO2 determinations were done before, immediately after and 30 minutes after chest physiotherapy in 4 groups (respiratory adaptation disturbance, pneumonia, hyaline membrane disease--controlled ventilation and RDS--nasal-CPAP) of mature and premature infants and in a group of healthy infants. The most striking alterations of the parameters investigated were found in infants treated with nasal-CPAP and controlled ventilation where especially a decrease of pH and increase of pCO2 was observed. After small increases of paO2 immediately after physiotherapy the paO2 values and concomitantly DAaO2 values 30 minutes after chest physiotherapy fell below the levels before physiotherapy. There was no significant change from pretreatment values in any group of infants. A physiotherapist experienced in the care of infants with respiratory diseases is most important for achieving satisfactory results.

Carbon Dioxide↗

"Aspiration disease".

Aspiration disease, a term used to define both an acute and chronic form of a disease entity, is described. Etiological factors, pathophysiology and therapy are discussed with emphasis on aspiration of gastric juice. A brief mention of a small clinical experience is included.

Acute Disease↗

Editorial: C.P.A.P.

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Evaluation Studies as Topic↗

Shock Lung.

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Humans↗