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The Conventional Ventilatory Support vs. Extracorporeal Membrane Oxygenation for Severe Adult Respiratory Failure (CESAR) Trial was a UK-based multicenter RCT aiming to evaluate the safety, efficacy and cost effectiveness of ECMO compared to conventional mechanical ventilation in adults with severe but reversible respiratory failure. [63]
Extracorporeal life support (ECLS) systems differ from traditional, theatre based, cardiac bypass machines in that they are portable and utilise percutaneous access as opposed to catheters which are surgically inserted into an open chest. The first access enters the femoral vein at the groin and is extended superiorly to the right atrium.
Acute respiratory distress syndrome was first described in 1967 by Ashbaugh et al. [10] [50] Initially there was no clearly established definition, which resulted in controversy regarding the incidence and death of ARDS. In 1988, an expanded definition was proposed, which quantified physiologic respiratory impairment.
In cases of overdose leading to respiratory arrest, the recommended treatment according to the 2015 American Heart Association guidelines is to administer intramuscular or intranasal naloxone at an initial dose of 0.04-0.4 mg. Dosing may be repeated up to 2 mg if initial dose is ineffective.
There are multiple factors during cardiopulmonary resuscitation (CPR) and defibrillation that are associated with success of achieving return of spontaneous circulation. . One of the factors in CPR is the chest compression fraction, which is a measure of how much time during cardiac arrest are chest compressions perfor
It is often impossible to distinguish TRALI from acute respiratory distress syndrome (ARDS). The typical presentation of TRALI is the sudden development of shortness of breath, severe hypoxemia (O 2 saturation <90% in room air), low blood pressure, and fever that develop within 6 hours after transfusion and usually resolve with supportive care within 48 to 96 hours.
Without special treatment after circulation is restarted, full recovery of the brain after more than 3 minutes of clinical death at normal body temperature is rare. [ 6 ] [ 7 ] Usually brain damage or later brain death results after longer intervals of clinical death even if the heart is restarted and blood circulation is successfully restored.
The permissive hypercapnia leads to respiratory acidosis which might have negative side effects, but given that the patient is in ARDS, improving ventilatory function is more important. Since hypoxemia is a major life-threatening condition and hypercapnia is not, one might choose to accept the latter. Hence the term, "permissive hypercapnia."