The authors treated five premature infants with idiopathic respiratory distress syndrome with ambroxol, using its action on type II pneumocytes and thus also on surfactant formation. In all infants improvement of the clinical condition was achieved, no side-effects were observed.

• MeSH
• ambroxol terapeutické užití   MeSH
• lidé MeSH
• novorozenec MeSH
• syndrom respirační tísně novorozenců farmakoterapie   MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Názvy látek
• ambroxol MeSH

Acute respiratory distress syndrome (ARDS) is the general term used for severe acute respiratory failure of diverse aetiology. It is associated with a high morbidity, mortality (50-70%), and financial costs. Regardless of aetiology, the basic pathogenesis of ARDS is a systemic inflammatory response leading to a diffuse inflammatory process that involves both lungs, thus causing diffuse alveolar and endothelial damage with increased pulmonary capillary permeability and excessive extravascular lung water accumulation. ARDS is commonly associated with sepsis and multiple organ failure. The clinical picture involves progressive hypoxaemia, radiographic evidence of pulmonary oedema, decreased lung compliance and pulmonary hypertension. Despite the scientific and technological progress in critical care medicine, there is no specific ARDS therapy available at the moment and its management remains supportive. Therapeutic goals include resolution of underlying conditions, maintenance of acceptable gas exchange and tissue oxygenation and prevention of iatrogenic lung injury. Many new specific therapeutic strategies have been developed, however, most of them require further scientific evaluation. The paper reviews definition, basic pathogenesis and pathophysiology of ARDS and discusses current concepts of therapeutic possibilities of ARDS.

• MeSH
• lidé MeSH
• syndrom dechové tísně * diagnóza   etiologie   patofyziologie   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

• MeSH
• lidé MeSH
• mortalita MeSH
• nemoci nedonošenců MeSH
• novorozenec MeSH
• syndrom respirační tísně novorozenců epidemiologie   MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• glukokortikoidy aplikace a dávkování   MeSH
• lidé MeSH
• novorozenec MeSH
• syndrom respirační tísně novorozenců prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• glukokortikoidy MeSH

• MeSH
• lidé MeSH
• novorozenec MeSH
• plicní surfaktanty terapeutické užití   MeSH
• syndrom respirační tísně novorozenců terapie   MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• plicní surfaktanty MeSH

Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of "European Guidelines for the Management of RDS" by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible. Methods of ongoing non-invasive respiratory support have been further refined and may help reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation by targeted use of postnatal corticosteroids remains essential. The general care of infants with RDS is also reviewed, including emphasis on appropriate cardiovascular support and judicious use of antibiotics as being important determinants of best outcome. We would like to dedicate this guideline to the memory of Professor Henry Halliday who died on November 12, 2022.These updated guidelines contain evidence from recent Cochrane reviews and medical literature since 2019. Strength of evidence supporting recommendations has been evaluated using the GRADE system. There are changes to some of the previous recommendations as well as some changes to the strength of evidence supporting recommendations that have not changed. This guideline has been endorsed by the European Society for Paediatric Research (ESPR) and the Union of European Neonatal and Perinatal Societies (UENPS).

• Klíčová slova
• Antenatal corticosteroids, Continuous positive airway pressure, Evidence-based practice, Mechanical ventilation, Non-invasive respiratory support, Nutrition, Oxygen supplementation, Patent ductus arteriosus, Preterm infant, Respiratory distress syndrome, Surfactant therapy, Thermoregulation,
• MeSH
• antibakteriální látky MeSH
• dítě MeSH
• kognice MeSH
• kojenec MeSH
• konsensus MeSH
• lidé MeSH
• novorozenec MeSH
• syndrom dechové tísně * MeSH
• syndrom respirační tísně novorozenců * terapie   MeSH
• těhotenství MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• směrnice pro lékařskou praxi MeSH
• Názvy látek
• antibakteriální látky MeSH

RATIONALE: High-frequency oscillatory ventilation (HFOV) is theoretically beneficial for lung protection, but the results of clinical trials are inconsistent, with study-level meta-analyses suggesting no significant effect on mortality. OBJECTIVES: The aim of this individual patient data meta-analysis was to identify acute respiratory distress syndrome (ARDS) patient subgroups with differential outcomes from HFOV. METHODS: After a comprehensive search for trials, two reviewers independently identified randomized trials comparing HFOV with conventional ventilation for adults with ARDS. Prespecified effect modifiers were tested using multivariable hierarchical logistic regression models, adjusting for important prognostic factors and clustering effects. MEASUREMENTS AND MAIN RESULTS: Data from 1,552 patients in four trials were analyzed, applying uniform definitions for study variables and outcomes. Patients had a mean baseline PaO2/FiO2 of 114 ± 39 mm Hg; 40% had severe ARDS (PaO2/FiO2 <100 mm Hg). Mortality at 30 days was 321 of 785 (40.9%) for HFOV patients versus 288 of 767 (37.6%) for control subjects (adjusted odds ratio, 1.17; 95% confidence interval, 0.94-1.46; P = 0.16). This treatment effect varied, however, depending on baseline severity of hypoxemia (P = 0.0003), with harm increasing with PaO2/FiO2 among patients with mild-moderate ARDS, and the possibility of decreased mortality in patients with very severe ARDS. Compliance and body mass index did not modify the treatment effect. HFOV increased barotrauma risk compared with conventional ventilation (adjusted odds ratio, 1.75; 95% confidence interval, 1.04-2.96; P = 0.04). CONCLUSIONS: HFOV increases mortality for most patients with ARDS but may improve survival among patients with severe hypoxemia on conventional mechanical ventilation.

• Klíčová slova
• acute respiratory distress syndrome, high-frequency oscillatory ventilation, mechanical ventilation,
• MeSH
• dospělí MeSH
• hypoxie terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• syndrom dechové tísně terapie   MeSH
• umělé dýchání metody   MeSH
• výsledek terapie MeSH
• vysokofrekvenční ventilace metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• srovnávací studie MeSH

BACKGROUND: Acute respiratory failure represents life-threatening disease with persistently marked mortality and late morbidity in pre-term newborns (RDS--respiratory distress syndrome), children as well as, adults (ARDS--acute respiratory distress syndrome). We are probably in the period when better understanding of pulmonary pathophysiology enables the development of new technologies that can help in decreasing the morbidity and mortality of patients with respiratory failure. One of these unconventional methods is partial liquid ventilation (PLV). MAIN PURPOSE: The main aim of the study was to verify the possibility of treating potentially reversible respiratory failure in patients where extracorporeal life support (ECLS) was contraindicated and extracorporeal membrane oxygenation (ECMO) could not be used, or the patient had not met the criteria for ECMO. METHODS: PLV was used in 6 children totally, in 7 applications with severe hypoxemic respiratory failure. Preoxygenated perfluorocarbon Rimar 101 (Miteni, Milan, Italy) warmed to 37 degrees C was applied intratracheally in the doses which corresponds with the functional residual capacity of lungs, the dose of perfluorocarbon was repeated every hour. Following parameters were recorded before, during and after PLV: pH, blood gases, ventilator setting, alveoloarterial difference for oxygen, dynamic compliance, and indices--oxygenation index and hypoxemia score (PaO2/FiO2). The values obtained 1 hour before PLV were compared with the values during PLV; the data before PLV and in the 3rd hour of PLV were evaluated statistically. RESULTS: Statistically significant increase of pH (7.22 vs 7.34, p < 0.05) and PaO2/FiO2 (72 vs 100 Torr, p < 0.01) and decrease of FiO2 (82% vs 64%, p < 0.05) and oxygenation index (23 vs 17, p < 0.05) occurred during 3 hours of PLV. CONCLUSION: Partial liquid ventilation is an effective method for controlling ARDS in certain groups of patients with severe lung disease. (Tab. 4, Ref. 15.)

• MeSH
• akutní nemoc MeSH
• dítě MeSH
• fluorokarbony aplikace a dávkování   MeSH
• kojenec MeSH
• lidé MeSH
• syndrom dechové tísně terapie   MeSH
• umělé dýchání metody   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• fluorokarbony MeSH

Acute respiratory distress syndrome (ARDS) is severe medical condition occurring in critically ill patients and with mortality of 33-52 % is one of the leading causes of death in critically ill patients. To better understand pathophysiology of ARDS and to verify novel therapeutical approaches a reliable animal model is needed. Therefore we have developed modified lavage model of ARDS in the pig. After premedication (ketamine and midazolam) 35 healthy pigs were anesthetized (propofol, midazolam, morphin, pipecuronium) and orotracheally intubated and ventilated. Primary ARDS was induced by repeated cycles of lung lavage with a detergent Triton X100 diluted in saline (0.03 %) heated to 37 °C preceded by pre-oxygenation with 100 % O(2). Single cycle included two subsequent lavages followed by detergent suction. Each cycle was followed by hemodynamic and ventilation stabilization for approx. 15 min, with eventual administration of vasopressors according to an arterial blood pressure. The lavage procedure was repeated until the paO(2)/FiO(2) index after stabilization remained below 100 at PEEP 5 cm H(2)O. In 33 pigs we have achieved the desired degree of severe ARDS (PaO(2)/FiO(2)<100). Typical number of lavages was 2-3 (min. 1, max. 5). Hemodynamic tolerance and the need for vasopressors were strongly individual. In remaining two animals an unmanageable hypotension developed. For other subjects the experimental ARDS stability was good and allowed reliable measurement for more than 10 h. The present model of the ARDS is clinically relevant and thus it is suitable for further research of the pathophysiology and management of this serious medical condition.

• MeSH
• bronchoalveolární laváž škodlivé účinky   metody   MeSH
• modely nemocí na zvířatech * MeSH
• plíce patologie   MeSH
• prasata MeSH
• Sus scrofa MeSH
• syndrom dechové tísně etiologie   patologie   MeSH
• zvířata MeSH
• Check Tag
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: There is considerable interest in oxygen partial pressure (Po2) monitoring in physiology, and in tracking Po2 changes dynamically when it varies rapidly. For example, arterial Po2 ([Formula: see text]) can vary within the respiratory cycle in cyclical atelectasis (CA), where [Formula: see text] is thought to increase and decrease during inspiration and expiration, respectively. A sensor that detects these [Formula: see text] oscillations could become a useful diagnostic tool of CA during acute respiratory distress syndrome (ARDS). METHODS: We developed a fibreoptic Po2 sensor (<200 µm diameter), suitable for human use, that has a fast response time, and can measure Po2 continuously in blood. By altering the inspired fraction of oxygen ([Formula: see text]) from 21 to 100% in four healthy animal models, we determined the linearity of the sensor's signal over a wide range of [Formula: see text] values in vivo. We also hypothesized that the sensor could measure rapid intra-breath [Formula: see text] oscillations in a large animal model of ARDS. RESULTS: In the healthy animal models, [Formula: see text] responses to changes in [Formula: see text] were in agreement with conventional intermittent blood-gas analysis (n=39) for a wide range of [Formula: see text] values, from 10 to 73 kPa. In the animal lavage model of CA, the sensor detected [Formula: see text] oscillations, also at clinically relevant [Formula: see text] levels close to 9 kPa. CONCLUSIONS: We conclude that these fibreoptic [Formula: see text] sensors have the potential to become a diagnostic tool for CA in ARDS.

• Klíčová slova
• acute respiratory distress syndrome, arterial oxygen monitoring, cyclical atelectasis, fibreoptic sensor,
• MeSH
• kyslík krev   MeSH
• modely nemocí na zvířatech MeSH
• prasata MeSH
• syndrom dechové tísně krev   MeSH
• technologie optických vláken MeSH
• zvířata MeSH
• Check Tag
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• kyslík MeSH