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Corticosteroids in acute respiratory distress syndrome
Fernandes, A.B.S.;Zin, W.A.;Rocco, P.R.M.;
Brazilian Journal of Medical and Biological Research , 2005, DOI: 10.1590/S0100-879X2005000200003
Abstract: improving the course and outcome of patients with acute respiratory distress syndrome presents a challenge. by understanding the immune status of a patient, physicians can consider manipulating proinflammatory systems more rationally. in this context, corticosteroids could be a therapeutic tool in the armamentarium against acute respiratory distress syndrome. corticosteroid therapy has been studied in three situations: prevention in high-risk patients, early treatment with high-dose, short-course therapy, and prolonged therapy in unresolving cases. there are differences between the corticosteroid trials of the past and recent trials: today, treatment starts 2-10 days after disease onset in patients that failed to improve; in the past, the corticosteroid doses employed were 5-140 times higher than those used now. additionally, in the past treatment consisted of administering one to four doses every 6 h (methylprednisolone, 30 mg/kg) versus prolonging treatment as long as necessary in the new trials (2 mg kg-1 day-1 every 6 h). the variable response to corticosteroid treatment could be attributed to the heterogeneous biochemical and molecular mechanisms activated in response to different initial insults. numerous factors need to be taken into account when corticosteroids are used to treat acute respiratory distress syndrome: the specificity of inhibition, the duration and degree of inhibition, and the timing of inhibition. the major continuing problem is when to administer corticosteroids and how to monitor their use. the inflammatory mechanisms are continuous and cyclic, sometimes causing deterioration or improvement of lung function. this article reviews the mechanisms of action of corticosteroids and the results of experimental and clinical studies regarding the use of corticosteroids in acute respiratory distress syndrome.
The Professional Medical Journal , 2006,
Abstract: Objectives: .To assess the safety, potential efficacy, morbidity andmortality of a small tidal volume mechanical ventilation strategy designed to reduce stretch induced lung injury in ARDS.Design: A prospective interventional experimental Setting: CMH Rawalpindi:..Period: .1st Sept 2001 to 30th June2002. Material & Methods: ARDS is a disease associated with high rate of mortality. It was a prospective interventionalexperimental study of 50 patients who underwent ventilatory support at intensive care unit of a tertiary care teachinghospital Combined Military Hospital Rawalpindi. Results: In both the Traditional Tidal Volume(TTV) and Small TidalVolume (STV) groups 15 of 26 patients [58%] achieved Reversal of Respiratory Failure (RRF). Of the patients whoachieved RRF, the mean number of days on positive pressure ventilation were 11.9±1.9 and 11.3 ± 2.2 days for theTV and STV patients respectively [not significant]. The mean number of days from the first day that weaning from MVwas allowed (when FI 02 was Keywords acute respiratory distress syndrome --- ARDS --- small tidal volume --- STV --- traditional tidal volume --- TTV --- reversal of respiratory failure --- RRF --- multiple organ dysfunction syndrome --- MODS
Acute lung injury and acute respiratory distress syndrome  [cached]
Ragaller Maximillian,Richter Torsten
Journal of Emergencies, Trauma and Shock , 2010,
Abstract: Every year, more information accumulates about the possibility of treating patients with acute lung injury or acute respiratory distress syndrome with specially designed mechanical ventilation strategies. Ventilator modes, positive end-expiratory pressure settings, and recruitment maneuvers play a major role in these strategies. However, what can we take from these experimental and clinical data to the clinical practice? In this article, we discuss substantial options of mechanical ventilation together with some adjunctive therapeutic measures, such as prone positioning and inhalation of nitric oxide.
Acute respiratory distress syndrome: epidemiology and management approaches  [cached]
Walkey AJ,Summer R,Ho V,Alkana P
Clinical Epidemiology , 2012,
Abstract: Allan J Walkey,1 Ross Summer,1 Vu Ho,1 Philip Alkana21The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA; 2Asthma Research Center, Brigham and Women's Hospital, Boston, MA, USAAbstract: Acute lung injury and the more severe acute respiratory distress syndrome represent a spectrum of lung disease characterized by the sudden onset of inflammatory pulmonary edema secondary to myriad local or systemic insults. The present article provides a review of current evidence in the epidemiology and treatment of acute lung injury and acute respiratory distress syndrome, with a focus on significant knowledge gaps that may be addressed through epidemiologic methods.Keywords: acute lung injury, acute respiratory distress syndrome, review, epidemiology
Acute Respiratory Distress Syndrome in Children  [cached]
Dincer Yildizdas,Ozden Ozgur Horoz,Ali Ertug Arslankoylu,Muge Sagiroglu
Arsiv Kaynak Tarama Dergisi , 2009,
Abstract: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are an important challenge for pediatric intensive care units. These disorders are characterized by a significant inflammatory response to a local (pulmonary) or remote (systemic) insult resulting in injury to alveolar epithelial and endothelial barriers of the lung, acute inflammation and protein rich pulmonary edema. The reported rates in children vary from 8.5 to 16 cases/1000 pediatric intensive care unit (PICU) admissions. The pathological features of ARDS are described as passing through three overlapping phases-an inflammatory or exudative phase (0-7 days), a proliferative phase (7-21 days) and lastly a fibrotic phase. The treatment of ARDS rests on good supportive care and control of initiating cause. Ventilatory modes and nursing interventions to optimize patient outcomes are identified. The goal of ventilating patients with ALI/ARDS should be to maintain adequate gas exchange. Lung protective mechanical ventilation with optimal lung recruitment is the mainstay of supportive therapy. This can be achieved by use of optimum PEEP, low tidal volume and appropriate FiO2. New therapeutic modalities refer to corticosteroid, high frequency ventilation, inhaled nitric oxide, prone positioning and surfactant treatment. Well-designed follow up studies are needed. [Archives Medical Review Journal 2009; 18(4.000): 241-259]
Protective - ventilation strategy in the acute respiratory distress syndrome  [PDF]
Bumba?irevi? Vladimir ?.,Bukumirovi? V.,Popovi? Nada,Nikoli? V.
Acta Chirurgica Iugoslavica , 2004, DOI: 10.2298/aci0403045b
Abstract: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) contribute to progressive hypoxemia in critically ill patients. It has been proved that conventional mechanical ventilation with physiological respiratory volume contributes to further lung damage. In this respect, application of protective ventilatory strategy - pulmonary ventilation with limited volume and pressure can avoid mentioned consequences. The aim of this paper is to discuss mechanims by which elements contained in protective mechanical ventilation of patients with ALI/ARDS prevent further progrssive lung injury, to argue the effects of positive end - expiratory pressure and present insturctions for its application.
Neuroleptic-induced acute respiratory distress syndrome
Soriano, Francisco Garcia;Vianna, Elcio dos Santos Oliveira;Velasco, Irineu Tadeu;
Sao Paulo Medical Journal , 2003, DOI: 10.1590/S1516-31802003000300007
Abstract: context: a case of neuroleptic malignant syndrome and acute respiratory distress syndrome is presented and discussed with emphasis on the role of muscle relaxation, creatine kinase, and respiratory function tests. case report: a 41-year-old man presented right otalgia and peripheral facial paralysis. a computed tomography scan of the skull showed a hyperdense area, 2 cm in diameter, in the pathway of the anterior intercommunicating cerebral artery. preoperative examination revealed: ph 7.4, paco2 40 torr, pao2 80 torr (room air), hb 13.8 g/dl, blood urea nitrogen 3.2 mmol/l, and creatinine 90 mmol/l. the chest x-ray was normal. the patient had not eaten during the 12-hour period prior to anesthesia induction. intravenous halothane, fentanyl 0.5 mg and droperidol 25 mg were used for anesthesia. after the first six hours, the pao2 was 65 torr (normal paco2) with fio2 50% (pao2/fio2 130), and remained at this level until the end of the operation 4 hours later, maintaining paco2 at 35 torr. a thrombosed aneurysm was detected and resected, and the ends of the artery were closed with clips. no vasospasm was present. this case illustrates that neuroleptic drugs can cause neuroleptic malignant syndrome associated with acute respiratory distress syndrome. neuroleptic malignant syndrome is a disease that is difficult to diagnose. acute respiratory distress syndrome is another manifestation of neuroleptic malignant syndrome that has not been recognized in previous reports: it may be produced by neuroleptic drugs independent of the manifestation of neuroleptic malignant syndrome. some considerations regarding the cause and effect relationship between acute respiratory distress syndrome and neuroleptic drugs are discussed. intensive care unit physicians should consider the possibility that patients receiving neuroleptic drugs could develop respiratory failure in the absence of other factors that might explain the syndrome.
Future Drugs for Treatment of Acute Respiratory Distress Syndrome  [PDF]
Afsaneh Vazin,Mojtaba Mojtahedzadeh,Ebrahim Salehifar,Noushin Rastkari
International Journal of Pharmacology , 2005,
Abstract: The acute respiratory distress syndrome (ARDS) is a common clinical disorder characterized by injury to the alveolar epithelial and endothelial barriers of the lung, acute inflammation and pro rich pulmonary edema leading to acute respiratory failure. Knowledge of the pathophysiology and management of ARDS has been improved immensely since its original description. But pharmacotherapies have not been hopeful in treatment of ARDS in clinical trials. Mortality from ARDS has decreased in certain centers over the last 10 years due to advances in supporting critically ill patients. This trend may open the window of opportunity for pharmacological manipulation of ARDS. This study reviews conventional and new treatment challenges like use of nitric oxide nebulizer, prostacycline, surfactants, anti-inflammatory agents, antioxidants, phosphodiesterase inhibitors, immunonutrients, prostaglandin E1, anti-interleukins and inhibitors of thromboxanes and leucotriens
Acute lung injury and the acute respiratory distress syndrome in the injured patient  [cached]
Bakowitz Magdalena,Bruns Brandon,McCunn Maureen
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2012, DOI: 10.1186/1757-7241-20-54
Abstract: Acute lung injury and acute respiratory distress syndrome are clinical entities of multi-factorial origin frequently seen in traumatically injured patients requiring intensive care. We performed an unsystematic search using PubMed and the Cochrane Database of Systematic Reviews up to January 2012. The purpose of this article is to review recent evidence for the pathophysiology and the management of acute lung injury/acute respiratory distress syndrome in the critically injured patient. Lung protective ventilation remains the most beneficial therapy. Future trials should compare intervention groups to controls receiving lung protective ventilation, and focus on relevant outcome measures such as duration of mechanical ventilation, length of intensive care unit stay, and mortality.
High frequency ventilation in acute respiratory distress syndrome: a case report
Carolina Friedrich Amoretti,Nelson Hamerschlak,Lucília Santana Faria,Luciana Branco Haddad
Einstein (S?o Paulo) , 2005,
Abstract: Acute Respiratory Distress Syndrome is a common entity thataffects patients with serious conditions and has a high mortalityrate. It was published ten years ago that pulmonary protectiveventilation, with low tidal volumes and high respiratory frequencies,would have a positive impact on the mortality rates of patientswith acute respiratory distress syndrome. Hence, the interest inhigh frequency ventilation has risen since it is as a safe and effectiveway to provide protective ventilation. This is a case report of apatient with congenital acute lymphoid leukemia, who progressedwith severe sepsis and acute respiratory distress syndrome andbenefited from high frequency ventilation.
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