RSDS adults at patients ONMK.

[Lena_S]

Dug, dug, and and has not found reanimation section of a forum. Here has solved here zapostit.

Share the information on the given problem (respiratory disstres a syndrome of lungs at adults on background ONMK, as imshemii there and hemorrhages) its or his treatments and the forecast. Thanks.

[Maxx]

It can? (there will be a need in full versions - inform the mail.)



J Neurosurg. 2001 Oct; 95 (4):560-8.



Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury.



Contant CF, Valadka AB, Gopinath SP, Hannay HJ, Robertson CS.



Department of Neurosurgery, Baylor College of Medicine, Houston, Texas 77030, USA.



OBJECT: The factors involved in the development of adult respiratory distress syndrome (ARDS) after severe head injury were studied. The presence of ARDS complicates the treatment of patients with severe head injury, both because hypoxia causes additional injury to the brain and because therapies that are used to protect the lungs and improve oxygenation in patients with ARDS can reduce cerebral blood flow (CBF) and increase intracranial pressure (ICP.) In a recent randomized trial of two head-injury management strategies (ICP-targeted and CBF-targeted), a fivefold increase in the incidence of ARDS was observed in the CBF-targeted group. METHODS: Injury severity, physiological data, and treatment data in 18 patients in whom ARDS had developed were compared with the remaining 171 patients in the randomized trial in whom it had not developed. Logistic regression analysis was used to study the interaction of the factors that were related to the development of ARDS. In the final exact logistic regression model, several factors were found to be significantly associated with an increased risk of ARDS: administration of epinephrine (5.7-fold increased risk), administration of dopamine in a larger than median dose (10.8-fold increased risk), and a history of drug abuse (3.1-fold increased risk). CONCLUSIONS: Although this clinical trial was not designed to study the association of management strategy and the occurrence of ARDS, the data strongly indicated that induced hypertension in this high-risk group of patients is associated with the development of symptomatic ARDS.





J Trauma. 2004 Sep; 57 (3):542-6.



High-frequency percussive ventilation: an alternative mode of ventilation for head-injured patients with adult respiratory distress syndrome.



Salim A, Miller K, Dangleben D, Cipolle M, Pasquale M.



Department of Surgery, Division of Trauma and Critical Care, University of Southern California Keck School of Medicine and the Los Angeles County-University of Southern California Medical Center, USA.



BACKGROUND: Adult respiratory distress syndrome develops in up to 20 % of patients with severe head injury. This complicates the treatment of head-injured patients because lung-protective strategies such as high positive end-expiratory pressure (PEEP) and permissive hypercapnia may increase intracranial pressure (ICP) and reduce cerebral perfusion pressure. The use of high-frequency percussive ventilation (HFPV) is an alternate mode of ventilation that may improve oxygenation for head-injured patients while also lowering ICP. METHODS: Clinical data were collected retrospectively over a 1-year period. Patients were included if they had a severe traumatic brain injury with a Glasgow Coma Score (GCS) of 8 or lower, a ventriculostomy drain for ICP measurement and cerebral spinal fluid drainage, and adult respiratory distress syndrome. Patients were switched from conventional mechanical ventilation to HFPV at the discretion of the attending trauma surgeon. Data for partial pressure of oxygen to fraction of inspired oxygen (PF) ratio, peak inspiratory pressure (PIP), ICP, partial pressure of carbon dioxide level (PCO2), PEEP, and mean airway pressure were compared before and then 4 and 16 hours after institution of HFPV therapy. RESULTS: A total of 10 patients met study criteria. Data were expressed as mean +/-standard error. There was an increase in PF ratio (91.8 +/-13.2 vs. 269.7 +/-34.6; p *lt; 0.01), PEEP (14 +/-2.5 vs. 16 +/-3.5), and mean airway pressure (20.4 +/-4.8 vs. 23.6 +/-6.8) 16 hours after institution of HFPV. There was a decrease in ICP (30.9 +/-3.4 vs. 17.4 +/-1.7; p *lt; 0.01), PC02 (37.7 +/-4.1 vs. 32.7 +/-1.1; p *lt; 0.05), and PIP (49.4 +/-10 vs. 41 +/-7.9; p *lt; 0.05) at 16 hours. Overall mortality was 10 %. CONCLUSIONS: Therapy with HFPV produced a significant improvement in oxygenation with a concomitant reduction in ICP during the first 16 hours. This therapy may represent an important new method for the management of adult respiratory distress syndrome among head-injured trauma patients, although the long-term outcome of HFPV still needs evaluation.

[Lenochka]

Dear Dr. Vad if you has text-through access the huge request send me. In advance thanks.

Narcotizatro@mail.ru

[girl]

It is not possible to send the letter on you to the specified address... Perhaps narcotozatOR?

[DmitrijZ]

Dear dr Evdoshenko,

Problem which you have mentioned or touched logically breaks up on two sostovljajushchie



1. Treatment (maintenance therapy) at patients with NMK (CVA).

2. Immediately veredenie the patient with ARDS



Important point of conducting the patient with CVA is kotrol arterial pressure. Actually, data recently began to appear what to reduce pressure it is not necessary (except for cases very much a high pressure more than 200-220). Absolutely precisely it is impossible to lower or omit pressure below 150-160. Not absolutely clearly, whether it is necessary to try is artificial to raise or increase pressure by means of neosinefrina. The hourly control of a glycemia over patients with Diabetum (most likely with vv infusion of an insulin) is important also. The control of a hyperthermia and probably operated or controlled hypothermia (at us in hospital special cooling blankets are used).

In occasion of ARDS - ventilation in low volumes (6-8 ml/kg) with higher value or meanings;importance PEEP. It is not absolutely understood a role rekrutingovyh in receptions and prone position ventilation.

[Vassssil]

IMHO, c the neurogenic fluid lungs meets extremely seldom. If to not take CHMT most often NOL it is described at a subarachnoidal hemorrhage, that forces to suspect more likely excessive addicting triple-H therapy. For an ischemic insult and VMK is in general kazuistika. In our conditions without measurement of parameters of the central hemodynamic very uneasy to differentiate NOL with a cardiogenic edema, and the aspiration not a rarity for ONMK.

The link (http: // www.chestjournal.org/cgi/reprint //111/5/1326) can will interest...

There is still a quite good review where this problem is discussed, Rochester CL, Mohsenin V. Respiratory Complications of Stroke. From Seminars respiratory critical care medicine. 2002; 23:248 - 260. If there is a desire, shall send the full text.

Yours faithfully.

P.S.: (alas, at a forum and the truth is not present reanimation section

[danya]

2alex_md you not so have understood me, she does not break up to 2 components, and on the contrary is going to. In it or this that and problemma. There is tactics of treatment ONMK and brain injuries. But on a background of damage of a brain there is an ARDS which too demands correction which nesovpadaet with therapy of a basic disease. High value or meaning;importance Peep very much are not desirable at nashchih patients. And variations from a BP not very much pozhhodjat for RDSV.Vot and a plug.

2thorn Frequently elements 3 therapies *quot; ia?O?O?n*quot; and at conducting ischemic damages of a brain, but there is no ARDS (I did not see such information if I shall is it is glad).

Thanks for participation. I shall learn your links.

ps: And can create reanimation section of a topic??