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  • 1
    ISSN: 1432-1238
    Keywords: Key words Adult respiratory distress syndrome ; Nitric oxide ; Sheep ; Lung lavage ; Pulmonary circulation ; Pressure-flow relationship
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: Inhalation of nitric oxide (NO) selectively dilates pulmonary vessels in well-ventilated regions. Prostaglandin F2α (PGF2α) is a vasoconstrictor and is reported to enhance hypoxic pulmonary vasoconstriction. The objective of this study was to examine whether the combination of intravenous PGF2α and inhaled NO in ARDS lungs has a beneficial effect on oxygenation. Design: We investigated the effect of intravenous PGF2α infusion (0.05–10.0 μg/kg per min) with and without NO inhalation (60 ppm) on the hemodynamics and gas exchange in an ovine ARDS model, examining the pulmonary artery pressure versus the flow plot by varying cardiac output. Measurements and results: After lung lavage, NO inhalation reduced the mean pulmonary arterial pressure (MPAP) by decreasing the zero-flow pressure intercept from 10.6±3.8 (mean±SD) to 8.5±3.8 mmHg (p〈0.05) with no significant change in slope. NO inhalation improved PaO2 from 56±12 to 84±38 mmHg (p〈0.005) and reduced pulmonary shunt from 65±5 to 53±8% (Qs/Qt) (p〈0.001). The dose-dependent effects of PGF2α infusion were: (1) increased MPAP attributed to an increased slope in pulmonary artery pressure-flow plot; (2) decreased cardiac index; (3) decreased Qs/Qt with unchanged PaO2. The dose-dependent decrease in Qs/Qt after PGF2α infusion was attributed to the decreased cardiac output. Conclusions: It is suggested that inhalation of NO reduced the critical vascular pressure near alveoli without affecting upstream vessels, while infused PGF2α constricted the larger upstream pulmonary artery vessels without appreciably affecting the critical pressure. Inhalation of NO into well-ventilated lung areas shifted perfusion to well-oxygenated areas, and there was no supplemental shift in blood flow by adding an infusion of PGF2α.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1238
    Keywords: Adult respiratory distress syndrome ; Sepsis ; Anti-endotoxin monoclonal antibodies ; HA-1A
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate the effects of HA-1A, a human monoclonal antiendotoxin antibody, in septic patients with ARDS. Design Substudy of a multicenter, double-blinded, placebo-controlled trial of HA-1A in septic patients. Patients 63 septic patients with ARDS at the time of study entry. Intervention A single intravenous injection of HA-1A (100 mg) or placebo. Results A quantitative radiographic score, the PaO2/FIO2 ratio and an index of the severity of ARDS did not show a significant difference between the treatment and placebo groups at 3, 5 and 7 days after treatment. The duration of endotracheal intubation did not differ between the two groups. 15 of 30 HA-1A treated patients (50%) and 23 of 33 placebo-treated patients (69.7%) died within 28 days. The daily mortality was always lower in the HA-1A group, but this difference was not statistically significant at 28 days. The 28-day survival curves for the two treatment groups adjusted by covariate analysis were not significantly different (p=0.07). Using logistic regression, a significant independent effect of HA-1A treatment was detected upon the early survival rate at 7 days (p=0.03) but not at 14 and 28 days. Conclusion A single injection of HA-1A in septic patients with ARDS did not reverse acute respiratory failure or improve long-term survival.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1238
    Keywords: Adult respiratory distress syndrome ; Nitric oxide ; Sheep ; Lung lavage ; Pulmonary circulation ; Pressure-flow relationship
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives Inhalation of nitric oxide (NO) selectively dilates pulmonary vessels in well-ventilated regions. Prostaglandin F2α (PGF2α) is a vasoconstrictor and is reported to enhance hypoxic pulmonary vasoconstriction. The objective of this study was to examine whether the combination of intravenous PGF2α and inhaled NO in ARDS lungs has a beneficial effect on oxygenation. Design We investigated the effect of intravenous PGF2α infusion (0.05–10.0 μg/kg per min) with and without NO inhalation (60 ppm) on the hemodynamics and gas exchange in an ovine ARDS model, examining the pulmonary artery pressure versure the flow plot by varying cardiac output. Measurements and results After lung lavage, NO inhalation reduced the mean pulmonary arterial pressure (MPAP) by decreasing the zero-flow pressure intercept from 10.6±3.8 (mean±SD) to 8.5±3.8 mmHg (p〈0.05) with no significant change in slope. NO inhalation improved PaO2 from 56±12 to 84±38 mmHg (p〈0.005) and reduced pulmonary shunt from 65±5 to 53±8% ( $$\dot Qs/\dot Qt$$ ) (p〈0.001). The dose-dependent effects of PGF2α infusion were: (1) increased MPAP attributed to an increased slope in pulmonary artery pressure-flow plot; (2) decreased cardiac index; (3) decreased $$\dot Qs/\dot Qt$$ with unchanged PaO2. The dose-dependent decrease in $$\dot Qs/\dot Qt$$ after PGF2α infusion was attributed to the decreased cardiac output. Conclusions It is suggested that inhalation of NO reduced the critical vascular pressure near alveoli without affecting upstream vessels, while infused PGF2α constricted the larger upstream pulmonary artery vessels without appreciably affecting the critical pressure. Inhalation of NO into well-ventilated lung areas shifted perfusion to well-oxygenated areas, and there was no supplemental shift in blood flow by adding an infusion of PGF2α.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 17 (1991), S. 69-70 
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-1238
    Keywords: Adult respiratory distress syndrome ; Zinc chloride toxicity ; Acute lung injury
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Five soldiers were injured by inhalation of hexite smoke (ZnCl2) during military training. Two soldiers, not wearing gas masks breathed hexite for 1 or 2 min, they slowly developed severe adult respiratory distress syndrome (ARDS) over the ensuing 2 weeks. This slow, progressive clinical course has not been previously described. In both patients, an increased plasma zinc concentration was measured 3 weeks after the incident. Intravenous and nebulized acetylcysteine increased the urinary excretion of zinc, and briefly decreased the plasma levels. In an attempt to arrest collagen deposition in the lungs, L-3,4 dehydroproline was administered. Both patients died of severe respiratory failure (25 and 32 days after inhalation). At autopsy diffuse microvascular obliteration, widespread occulusion of the pulmonary arteries and extensive interstitial and intra-alveolar fibrosis was observed. Three soldiers wearing ill fitting gas masks, immediately developed severe coughing and dyspnea. They improved, and 12 months after exposure their lung function tests were nearly normal, but they still had slight dyspnea on exercise.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 19 (1993), S. 433-434 
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 14 (1988), S. 178-179 
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 14 (1988), S. 448-457 
    ISSN: 1432-1238
    Keywords: Right ventricle ; Thermodilution ; Ejection fraction ; Acute respiratory failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This paper reviews right ventricular anatomy and physiology in the critically ill patient. The role of right ventricular function during acute pulmonary artery hypertension and the effect of acute myocardial injury upon right ventricular performance are examined. Clinical methods of assessing right ventricular function at the bedside in acutely ill patients are critically reviewed.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1573-4919
    Keywords: ischemia ; O2 lack ; high energy phosphates ; mitochondrial respiration
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Chemistry and Pharmacology , Medicine
    Notes: Abstract During periods of O2 lack in liver of seals, mitochondrial respiration and adenosine triphosphate (ATP) synthesis are necessarily arrested. During such electron transfer system (ETS) arrest, the mitochondria are suspended in functionally protected states; upon resupplying O2 and adenosine diphosphate (ADP), coupled respiration and ATP synthesis can resume immediately, implying that mitochondrial electrochemical potentials required for ATP synthesis are preserved during ischemia. A similar situation occurs in the rest of the cell since ion gradients also seem to be maintained across the plasma membrane; with ion-specific channels seemingly relatively inactive, ion fluxes (e.g., K+ efflux and Ca++ influx) can be reduced, consequently reducing ATP expenditure for ion pumping. The need for making up energy shortfalls caused by ETS arrest is thus minimized, which is why anaerobic glycolysis can be held in low activity states (anaerobic ATP turnover rates being reduced in ischemia to less than 1/100 of typical normoxic rates in mammalian liver and to about 1/10 the rates expected during liver hypoperfusion in prolonged diving). As in many ectotherms, an interesting parallelism (channel arrest coupled with a proportionate metabolic arrest at the level of both glycolysis and the ETS) appears as the dominant hypoxia defense strategy in a hypoxia-tolerant mammalian organ.
    Type of Medium: Electronic Resource
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