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Mortality at 60 days was the primary endpoint. The calculated sample size was 331 patients with an intent to show a 20% reduction in absolute mortality in the ECMO group. The main secondary endpoint was treatment failure – cross-over to ECMO due to refractory hypoxemia or death in the control group and death in the ECMO group.
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.
Similarly as with adults ECMO is only indicated if reversal of the pathology for example with cardiac transplantation, is feasible. [27] When it comes to the consideration of the withdrawal of ECMO, unlike in adult populations parents are encouraged to make the final decision with guidance from the treating physicians.
For example, adjusted ICU mortality (for a patient at average predicted risk for ICU death) was 21.2% in hospitals with 87 to 150 mechanically ventilated patients annually, and 14.5% in hospitals with 401 to 617 mechanically ventilated patients annually. Hospitals with intermediate numbers of patients had outcomes between these extremes.
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.
Treatment of the underlying cause is required, if possible. The treatment of acute respiratory failure may involve medication such as bronchodilators (for airways disease), [7] [8] antibiotics (for infections), glucocorticoids (for numerous causes), diuretics (for pulmonary oedema), amongst others.
Clinically, the most serious and immediate complication is acute respiratory distress syndrome (ARDS), which usually occurs within 24 hours. [30] [31] [32] Those with significant lower airway involvement may develop bacterial infection. Importantly, victims suffering body surface burn and smoke inhalation are the most susceptible.
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.