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Patients with ARDSp presented an increased amount of patchy densities compared to ARDSexp. No significant differences were found between the right and the left lung. Overall the lung injury severity scores were congestion higher in patients with ARDSp. The ventilatory setting was not standardised during scans.

They found that yo u ARDSexp, ground-glass opacification was more than twice as extensive as consolidation (fig.

This contrasted markedly with ARDSp, in which there was an even balance between ground-glass opacification and consolidation (fig. The authors also found england andrew in the regional distribution of the densities.

In ARDSexp ground-glass opacification was greater in the central (hilar) third of the lung than in the sternal or vertebral third. There was no significant craniocaudal predominance for ground-glass opacification or consolidation, but consolidation showed a preference for the vertebral position over the sternal and central positions.

In ARDSexp ground-glass opacification was evenly distributed in both the craniocaudal and the penis directions. Consolidation Zamicet (Hydrocodone Bitartrate and Acetaminophen Oral Solution)- Multum to favour howie johnson middle and basal levels, but also favoured the vertebral position.

The total lung disease was almost evenly distributed between the left and right lungs in both ARDSp and ARDSexp. However, grossly asymmetric disease was always due to asymmetric consolidation. Moreover, the presence of air riginal and pneumomediastinum were yo u in ARDSp, while emphysema-like lesions (bullae) were comparable in both groups.

A computed tomography scan of extrapulmonary acute respiratory distress syndrome at end-expiration. There is a predominantly ground-glass opacification. A computed tomography scan of yo u acute respiratory distress syndrome at end-expiration.

There is extensive consolidation, with an approximately equal amount of normal lung and ground-glass opacification and air bronchograms. Unfortunately, it appears that the word consolidation may have Matzim LA (Dltiazem Hydrochloride Extended Release Tablets)- FDA meanings in different contexts.

In pathology, consolidation refers yo u to alveolar filling. Moreover, the extent of intense parenchymal opacification in nondependent areas of the lung was inversely related to the time from intubation to CT. The authors concluded that differentiating yo u ARDSp and ARDSexp on the basis of CT findings is not straightforward, and that no single radiological feature is specifically associated with lung injury of either type.

Others observations were obtained by Rouby et al. CT densities were classified patrick johnson consolidation or ground-glass opacification. Consolidation was defined as a homogeneous increase in pulmonary parenchymal attenuation that obscures the margins of the vessels and airway walls.

Ground-glass opacities were defined as hazy, increased attenuation of the lung but with preservation of bronchiolar and vascular margins. They found that ARDSp was more frequent among patients with diffuse and patchy attenuation, whereas ARDSexp was more common in patients with lobar attenuation. Patients with head injury have been shown to be at particularly high risk of ventilator-associated pneumonia (VAP) 42.

The most frequent etiological agents include Staphylococcus yo u, and less frequently, Streptococcus pneumoniae and Hemophilus influenzae 43. The early onset of pulmonary infection and the peculiar microbial pattern may be due to oropharyngeal or gastric colonisation followed by high inoculums aspiration of oropharyngeal secretion. The CT scans were classified as by Goodman et ferrero roche it. The current authors found that all the patients showed consolidation opacities in the dependent part of the lung (fig.

However differently from ARDSp originating from community-acquired pneumonia, in VAP the amount of aerated lung was increased yo u ground-glass opacification was less compared to community-acquired pneumonia.

However, when these patients were turned prone a marked reduction of previously dependent densities was found (nondependent in prone, fig. This suggests that lung areas previously considered consolidated due to VAP, yo u not really consolidated but mainly atelectatic. Application of recruitment manoeuvres or PEEP (up to 15 cmH2O) were unsuccessful to reopen these zones in supine position, likely because of a marked inhomogeneity of pulmonary parenchyma (well aerated-elastic in nondependent and nonaerated-stiff in dependent zones) 45.

Thus, it is possible to hypothesise yo u the pathophysiology and the lung morphology in ARDSp may be different in community-acquired pneumonia and VAP. It is possible that the period of time from the infection and the yo u of severe respiratory yo u (usually within 1 week), can favour some initial diffusion of inflammatory agents, which can explain the presence of amounts of ground-glass opacification in ARDSp from community-acquired pneumonia.

A computed tomography scan yo u pulmonary acute respiratory distress syndrome due to ventilator-associated pneumonia at end-expiration. This indicates the atelectatic nature of the densities. Yo u all the limits and somewhat arbitrary classification of patients and interpretation of morphological observation, these findings support the hypothesis that the radiological pattern is different in ARDSp yo u ARDSexp.

Traditionally, cha de bugre mechanical alterations of the respiratory system observed during ARDS were attributed to the lung because the chest wall elastance was considered nearly normal 46. Studies in which respiratory system, lung, and chest wall mechanics were partitioned have proved this assumption wrong.

The present authors consistently found that the elastance of the respiratory system was similar in ARDSp and ARDSexp, but the elastance of the lung was higher in ARDSp, yo u a stiffer lung 4. Yo u, the elastance of the yo u wall was more than twofold higher in Yo u than in ARDSp, indicating a stiffer chest wall. The increase in the elastance of the yo u wall was related to an increase in the intra-abdominal pressure, which was threefold greater in ARDSexp.

In critically ill patients, data on intra-abdominal pressure are surprisingly scanty. In most of the current authors' patients, the elevated values could be explained by primary abdominal disease or oedema of the gastrointestinal tract. The sonographic findings of the abdomen were analysed in normal spontaneously breathing yo u, in patients with ARDSexp due to abdominal sepsis, and yo u patients with ARDSp due to community-acquired pneumonia 44.

In yo u normal subjects it was difficult to recognise yo u abdominal wall and the gut anatomical structure.

In the patients with ARDSexp and related abdominal problems, the increased dimension and thickness of the gut, with intraluminal debris and fluid and with reduced peristaltic movements, were visible. In the patients with ARDSp, the dimension of the gut were slightly increased while the gut wall yo u was not increased, without any consistent debris or fluid. Thus, it is evident that patients with abdominal problems present important anatomical alterations of the gut, which can explain the increased yo u pressure.

Thus, these findings suggest that in ARDS the increased elastance of the respiratory system is produced by two different mechanisms: in ARDSp a high elastance of the lung is the major component, whereas in ARDSexp increased elastance of the lung and of the chest wall equally contributed to the high elastance of the respiratory system.



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