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العنوان
Extracorporeal Membrane Oxygenation and Novel Modalities in Management of ARDS /
المؤلف
Wahba, Mina Samy Ibrahim.
هيئة الاعداد
باحث / مينا سامي إبراهيم وهبة
مشرف / سيف الإسلام عبدالعزيزعبدالحميد شاهين
مشرف / شريف فاروق إبراهيم الشنتوري
مشرف / رفيق عماد لطيف دوس
تاريخ النشر
2016.
عدد الصفحات
126 P. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
العناية المركزة والطب العناية المركزة
تاريخ الإجازة
1/1/2016
مكان الإجازة
جامعة عين شمس - كلية الطب - Intensive Care
الفهرس
Only 14 pages are availabe for public view

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Abstract

The lung has two essential, interdependent functions. One function is ventilation-perfusion matching to deliver oxygen to the body and to remove carbon dioxide that is produced by the body. The second function is host defense against the onslaught of airborne pathogens, chemicals, and particulates. These essential functions are emphasized through the gross, subgross, histologic, and ultrastructural determinants of respiratory gas exchange in the normal human lung.
The lungs and the chest wall are elastic structures. Normally, no more than a thin layer of fluid is present between the lungs and the chest wall (intra-pleural space). The lungs slide easily on the chest wall, but resist being pulled away from it in the same way that two moist pieces of glass slide on each other but resist separation. The pressure in the “space” between the lungs and chest wall (intrapleural pressure) is subatmospheric. The lungs are stretched when they expand at birth, and at the end of quiet expiration their tendency to recoil from the chest wall is just balanced by the tendency of the chest wall to recoil in the opposite direction.
ARDS is characterized by noncardiogenic pulmonary edema, lung inflammation, hypoxemia, and decreased lung compliance. The pathogenesis of ARDS remains elusive and there is no gold standard diagnostic test. The heterogeneity of the clinical conditions associated with ARDS would be consistent with the possibility that ARDS is in fact a collection of different diseases that have not yet been separately identified.
ECMO consists of an extracorporeal circuit with a gas exchange device, referred to as an oxygenator, which directly oxygenates and removes carbon dioxide from the blood across a semipermeable membrane. Deoxygenated blood is withdrawn through a drainage cannula via an external pump, passes through the oxygenator, and is returned to the patient through a reinfusion cannula.
Novel modalities which may have role in management of ARDS includes: beta agonists, surfactant, nitric oxide, prostacyclin, steroids, ketoconazole, Neutrophil elastase inhibitors, ibuprofen, antioxidants, glutathione, Pentoxifylline, Lisofylline, dietary oil supplementation and novel ventilation strategies as high-frequency oscillatory ventilation and liquid ventilation.