Clinics in chest medicine
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Clinics in chest medicine · Dec 2014
ReviewApproach to the patient with the acute respiratory distress syndrome.
Given the high incidence and mortality of acute respiratory distress syndrome (ARDS) in critically ill patients, every practitioner needs a bedside approach both for early identification of patients at risk for ARDS and for the appropriate evaluation of patients who meet the diagnostic criteria of ARDS. Recent advances such as the Lung Injury Prediction score, the Early Acute Lung Injury score, and validation of the SpO(2)/Fio(2) ratio for assessing the degree of hypoxemia are all practical tools to aid the practitioner in caring for patients at risk of ARDS.
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Clinics in chest medicine · Dec 2014
ReviewExtracorporeal circulatory approaches to treat acute respiratory distress syndrome.
The early history of extracorporeal membrane oxygenation (ECMO) for adult patients with the acute respiratory distress syndrome (ARDS) evolved slowly over decades, a consequence of extracorporeal technology with high risk and unclear benefit. However, advances in component technology, accumulating evidence, and growing experience in recent years have resulted in a resurgence of interest in ECMO. Extracorporeal support, though currently lacking high-level evidence, has the potential to improve outcomes, including survival, in ARDS. In the near future, novel extracorporeal management strategies may, in fact, lead to a new paradigm in the approach to certain patients with ARDS.
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Clinics in chest medicine · Dec 2014
ReviewEndogenous and exogenous cell-based pathways for recovery from acute respiratory distress syndrome.
Regenerative medicine has entered a rapid phase of discovery, and much has been learned in recent years about the lung's response to injury. This article first summarizes the cellular and molecular mechanisms that damage the alveolar-capillary barrier, producing acute respiratory distress syndrome (ARDS). The latest understanding of endogenous repair processes is discussed, highlighting the diversity of lung epithelial progenitor cell populations and their regulation in health and disease. Finally, the past, present, and future of exogenous cell-based therapies for ARDS is reviewed.
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Clinics in chest medicine · Dec 2014
ReviewThe use of paralytics in patients with acute respiratory distress syndrome.
Interest in the role of neuromuscular blocking agents (NMBAs) in the treatment of acute respiratory distress syndrome (ARDS) has been renewed since a recent randomized clinical trial showed a reduction in mortality associated with the use of NMBAs. However, the role of paralytics in a protective mechanical ventilation strategy should be detailed. This review summarizes data in the literature concerning the clinical effects of NMBAs on the outcome of patients with ARDS, in an attempt to explain some pathophysiologic hypotheses concerning their action and to integrate them into the overall management strategy for the mechanical ventilation of ARDS patients.
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Clinics in chest medicine · Dec 2014
ReviewClinical and biological heterogeneity in acute respiratory distress syndrome: direct versus indirect lung injury.
The acute respiratory distress syndrome (ARDS) is a heterogeneous group of illnesses affecting the pulmonary parenchyma with acute onset bilateral inflammatory pulmonary infiltrates with associated hypoxemia. ARDS occurs after 2 major types of pulmonary injury: direct lung injury affecting the lung epithelium or indirect lung injury disrupting the vascular endothelium. Greater understanding of the differences between direct and indirect lung injury may refine the classification of patients with ARDS and lead to development of new therapeutics targeted at specific subpopulations of patients with ARDS.