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The New England Journal of Medicine Aug 2017
Review
Topics: Combined Modality Therapy; Fluid Therapy; Humans; Lung; Radiography; Respiration, Artificial; Respiratory Distress Syndrome; Risk Factors
PubMed: 28792873
DOI: 10.1056/NEJMra1608077 -
American Family Physician Oct 2007The most common etiology of neonatal respiratory distress is transient tachypnea of the newborn; this is triggered by excessive lung fluid, and symptoms usually resolve... (Review)
Review
The most common etiology of neonatal respiratory distress is transient tachypnea of the newborn; this is triggered by excessive lung fluid, and symptoms usually resolve spontaneously. Respiratory distress syndrome can occur in premature infants as a result of surfactant deficiency and underdeveloped lung anatomy. Intervention with oxygenation, ventilation, and surfactant replacement is often necessary. Prenatal administration of corticosteroids between 24 and 34 weeks' gestation reduces the risk of respiratory distress syndrome of the newborn when the risk of preterm delivery is high. Meconium aspiration syndrome is thought to occur in utero as a result of fetal distress by hypoxia. The incidence is not reduced by use of amnio-infusion before delivery nor by suctioning of the infant during delivery. Treatment options are resuscitation, oxygenation, surfactant replacement, and ventilation. Other etiologies of respiratory distress include pneumonia, sepsis, pneumothorax, persistent pulmonary hypertension, and congenital malformations; treatment is disease specific. Initial evaluation for persistent or severe respiratory distress may include complete blood count with differential, chest radiography, and pulse oximetry.
Topics: Algorithms; Diagnosis, Differential; Humans; Infant, Newborn; Meconium Aspiration Syndrome; Respiration Disorders; Respiratory Distress Syndrome, Newborn
PubMed: 17956068
DOI: No ID Found -
American Family Physician Dec 2015Newborn respiratory distress presents a diagnostic and management challenge. Newborns with respiratory distress commonly exhibit tachypnea with a respiratory rate of...
Newborn respiratory distress presents a diagnostic and management challenge. Newborns with respiratory distress commonly exhibit tachypnea with a respiratory rate of more than 60 respirations per minute. They may present with grunting, retractions, nasal flaring, and cyanosis. Common causes include transient tachypnea of the newborn, respiratory distress syndrome, meconium aspiration syndrome, pneumonia, sepsis, pneumothorax, persistent pulmonary hypertension of the newborn, and delayed transition. Congenital heart defects, airway malformations, and inborn errors of metabolism are less common etiologies. Clinicians should be familiar with updated neonatal resuscitation guidelines. Initial evaluation includes a detailed history and physical examination. The clinician should monitor vital signs and measure oxygen saturation with pulse oximetry, and blood gas measurement may be considered. Chest radiography is helpful in the diagnosis. Blood cultures, serial complete blood counts, and C-reactive protein measurement are useful for the evaluation of sepsis. Most neonates with respiratory distress can be treated with respiratory support and noninvasive methods. Oxygen can be provided via bag/mask, nasal cannula, oxygen hood, and nasal continuous positive airway pressure. Ventilator support may be used in more severe cases. Surfactant is increasingly used for respiratory distress syndrome. Using the INSURE technique, the newborn is intubated, given surfactant, and quickly extubated to nasal continuous positive airway pressure. Newborns should be screened for critical congenital heart defects via pulse oximetry after 24 hours but before hospital discharge. Neonatology consultation is recommended if the illness exceeds the clinician's expertise and comfort level or when the diagnosis is unclear in a critically ill newborn.
Topics: Continuous Positive Airway Pressure; Education, Medical, Continuing; Female; Humans; Infant, Newborn; Intubation; Male; Practice Guidelines as Topic; Respiratory Distress Syndrome, Newborn; Surface-Active Agents; Treatment Outcome
PubMed: 26760414
DOI: No ID Found -
Pediatric Critical Care Medicine : a... Jun 2015To describe the final recommendations of the Pediatric Acute Lung Injury Consensus Conference.
OBJECTIVE
To describe the final recommendations of the Pediatric Acute Lung Injury Consensus Conference.
DESIGN
Consensus conference of experts in pediatric acute lung injury.
SETTING
Not applicable.
SUBJECTS
PICU patients with evidence of acute lung injury or acute respiratory distress syndrome.
INTERVENTIONS
None.
METHODS
A panel of 27 experts met over the course of 2 years to develop a taxonomy to define pediatric acute respiratory distress syndrome and to make recommendations regarding treatment and research priorities. When published, data were lacking a modified Delphi approach emphasizing strong professional agreement was used.
MEASUREMENTS AND MAIN RESULTS
A panel of 27 experts met over the course of 2 years to develop a taxonomy to define pediatric acute respiratory distress syndrome and to make recommendations regarding treatment and research priorities. When published data were lacking a modified Delphi approach emphasizing strong professional agreement was used. The Pediatric Acute Lung Injury Consensus Conference experts developed and voted on a total of 151 recommendations addressing the following topics related to pediatric acute respiratory distress syndrome: 1) Definition, prevalence, and epidemiology; 2) Pathophysiology, comorbidities, and severity; 3) Ventilatory support; 4) Pulmonary-specific ancillary treatment; 5) Nonpulmonary treatment; 6) Monitoring; 7) Noninvasive support and ventilation; 8) Extracorporeal support; and 9) Morbidity and long-term outcomes. There were 132 recommendations with strong agreement and 19 recommendations with weak agreement. Once restated, the final iteration of the recommendations had none with equipoise or disagreement.
CONCLUSIONS
The Consensus Conference developed pediatric-specific definitions for acute respiratory distress syndrome and recommendations regarding treatment and future research priorities. These are intended to promote optimization and consistency of care for children with pediatric acute respiratory distress syndrome and identify areas of uncertainty requiring further investigation.
Topics: Age Factors; Blood Gas Analysis; Comorbidity; Extracorporeal Membrane Oxygenation; Humans; Intensive Care Units, Pediatric; Monitoring, Physiologic; Radiography, Thoracic; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Severity of Illness Index; Time Factors
PubMed: 25647235
DOI: 10.1097/PCC.0000000000000350 -
Intensive Care Medicine Feb 2014Pain, dyspnea, and thirst are three of the most prevalent, intense, and distressing symptoms of intensive care unit (ICU) patients. In this report, the interdisciplinary... (Review)
Review
PURPOSE
Pain, dyspnea, and thirst are three of the most prevalent, intense, and distressing symptoms of intensive care unit (ICU) patients. In this report, the interdisciplinary Advisory Board of the Improving Palliative Care in the ICU (IPAL-ICU) Project brings together expertise in both critical care and palliative care along with current information to address challenges in assessment and management.
METHODS
We conducted a comprehensive review of literature focusing on intensive care and palliative care research related to palliation of pain, dyspnea, and thirst.
RESULTS
Evidence-based methods to assess pain are the enlarged 0-10 Numeric Rating Scale (NRS) for ICU patients able to self-report and the Critical Care Pain Observation Tool or Behavior Pain Scale for patients who cannot report symptoms verbally or non-verbally. The Respiratory Distress Observation Scale is the only known behavioral scale for assessment of dyspnea, and thirst is evaluated by patient self-report using an 0-10 NRS. Opioids remain the mainstay for pain management, and all available intravenous opioids, when titrated to similar pain intensity end points, are equally effective. Dyspnea is treated (with or without invasive or noninvasive mechanical ventilation) by optimizing the underlying etiological condition, patient positioning and, sometimes, supplemental oxygen. Several oral interventions are recommended to alleviate thirst. Systematized improvement efforts addressing symptom management and assessment can be implemented in ICUs.
CONCLUSIONS
Relief of symptom distress is a key component of critical care for all ICU patients, regardless of condition or prognosis. Evidence-based approaches for assessment and treatment together with well-designed work systems can help ensure comfort and related favorable outcomes for the critically ill.
Topics: Critical Care; Dyspnea; Humans; Intensive Care Units; Pain Management; Pain Measurement; Palliative Care; Quality Improvement; Thirst
PubMed: 24275901
DOI: 10.1007/s00134-013-3153-z -
Clinics in Chest Medicine Mar 2017Respiratory viruses are a common cause of severe pneumonia and acute respiratory distress syndrome (ARDS) in adults. The advent of new diagnostic technologies,... (Review)
Review
Respiratory viruses are a common cause of severe pneumonia and acute respiratory distress syndrome (ARDS) in adults. The advent of new diagnostic technologies, particularly multiplex reverse transcription polymerase chain reaction, have increased the recognition of viral respiratory infections in critically ill adults. Supportive care for adults with ARDS caused by respiratory viruses is similar to the care of patients with ARDS from other causes. Although antiviral therapy is available for some respiratory viral infections, further research is needed to determine which groups of patients would benefit.
Topics: Humans; Male; Pneumonia, Viral; Respiratory Distress Syndrome
PubMed: 28159154
DOI: 10.1016/j.ccm.2016.11.013 -
European Annals of Otorhinolaryngology,... Feb 2019Newborns are obligatory nasal breathers. Therefore, nasal obstruction can lead to cyanosis and desaturation. In spite of being very rare, congenital bilateral...
INTRODUCTION
Newborns are obligatory nasal breathers. Therefore, nasal obstruction can lead to cyanosis and desaturation. In spite of being very rare, congenital bilateral dacryocystocele is a possible etiology for neonatal respiratory distress.
CASE SUMMARY
Case report of a male newborn with respiratory distress caused by a bilateral polypoid and bluish lesion occupying almost the entire inferior nasal meatus. Imaging confirmed bilateral dacryocystocele. Treatment was conservative. There was spontaneous drainage, with relief of respiratory distress. Discussion The diagnosis of congenital dacryocystocele is clinical, although imaging exams may be requested to confirm it. Treatment is controversial, because the natural history is variable. An initial conservative management may be recommended, but, if there is a permanent respiratory obstruction without improvement, surgical management is mandatory.
Topics: Anti-Bacterial Agents; Conservative Treatment; Humans; Infant, Newborn; Lacrimal Apparatus Diseases; Male; Massage; Mucocele; Nasal Obstruction; Nose Diseases; Respiratory Distress Syndrome, Newborn
PubMed: 30337239
DOI: 10.1016/j.anorl.2017.10.006 -
Revista Brasileira de Terapia Intensiva 2015Acute respiratory distress syndrome is a disease of acute onset characterized by hypoxemia and infiltrates on chest radiographs that affects both adults and children of... (Review)
Review
Acute respiratory distress syndrome is a disease of acute onset characterized by hypoxemia and infiltrates on chest radiographs that affects both adults and children of all ages. It is an important cause of respiratory failure in pediatric intensive care units and is associated with significant morbidity and mortality. Nevertheless, until recently, the definitions and diagnostic criteria for acute respiratory distress syndrome have focused on the adult population. In this article, we review the evolution of the definition of acute respiratory distress syndrome over nearly five decades, with a special focus on the new pediatric definition. We also discuss recommendations for the implementation of mechanical ventilation strategies in the treatment of acute respiratory distress syndrome in children and the use of adjuvant therapies.
Topics: Adult; Age Factors; Child; Humans; Intensive Care Units, Pediatric; Respiration, Artificial; Respiratory Distress Syndrome; Respiratory Insufficiency
PubMed: 26331971
DOI: 10.5935/0103-507X.20150035 -
Missouri Medicine 2012Acute Respiratory Distress Syndrome (ARDS) is defined by bilateral diffuse infiltrates on chest radiography, a PO2/FiO2 ratio < 200, and noncardiogenic pulmonary edema.... (Review)
Review
Acute Respiratory Distress Syndrome (ARDS) is defined by bilateral diffuse infiltrates on chest radiography, a PO2/FiO2 ratio < 200, and noncardiogenic pulmonary edema. Pathophysiologically it is characterized by disruption of the alveolar lining and capillary endothelium, alveolar edema, protein exudation coupled with a marked inflammatory response and subsequent fibrosis and a resultant ventilation-perfusion mismatch. Effective treatment strategies include low tidal volume ventilation with positive end expiratory pressure, careful fluid management and good supportive care.
Topics: Humans; Inflammation Mediators; Nutritional Status; Positive-Pressure Respiration; Respiration, Artificial; Respiratory Distress Syndrome; Treatment Outcome
PubMed: 23097941
DOI: No ID Found -
American Family Physician Feb 2012Acute respiratory distress syndrome manifests as rapidly progressive dyspnea, tachypnea, and hypoxemia. Diagnostic criteria include acute onset, profound hypoxemia,... (Review)
Review
Acute respiratory distress syndrome manifests as rapidly progressive dyspnea, tachypnea, and hypoxemia. Diagnostic criteria include acute onset, profound hypoxemia, bilateral pulmonary infiltrates, and the absence of left atrial hypertension. Acute respiratory distress syndrome is believed to occur when a pulmonary or extrapulmonary insult causes the release of inflammatory mediators, promoting neutrophil accumulation in the microcirculation of the lung. Neutrophils damage the vascular endothelium and alveolar epithelium, leading to pulmonary edema, hyaline membrane formation, decreased lung compliance, and difficult air exchange. Most cases of acute respiratory distress syndrome are associated with pneumonia or sepsis. It is estimated that 7.1 percent of all patients admitted to an intensive care unit and 16.1 percent of all patients on mechanical ventilation develop acute lung injury or acute respiratory distress syndrome. In-hospital mortality related to these conditions is between 34 and 55 percent, and most deaths are due to multiorgan failure. Acute respiratory distress syndrome often has to be differentiated from congestive heart failure, which usually has signs of fluid overload, and from pneumonia. Treatment of acute respiratory distress syndrome is supportive and includes mechanical ventilation, prophylaxis for stress ulcers and venous thromboembolism, nutritional support, and treatment of the underlying injury. Low tidal volume, high positive end-expiratory pressure, and conservative fluid therapy may improve outcomes. A spontaneous breathing trial is indicated as the patient improves and the underlying illness resolves. Patients who survive acute respiratory distress syndrome are at risk of diminished functional capacity, mental illness, and decreased quality of life; ongoing care by a primary care physician is beneficial for these patients.
Topics: Adrenal Cortex Hormones; Anticoagulants; Diagnosis, Differential; Heparin, Low-Molecular-Weight; Humans; Incidence; Respiration, Artificial; Respiratory Distress Syndrome; Risk Factors
PubMed: 22335314
DOI: No ID Found