Critical care clinics
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Critical care clinics · Jul 2011
ReviewInhaled nitric oxide and inhaled prostacyclin in acute respiratory distress syndrome: what is the evidence?
The mortality for acute respiratory distress syndrome remains unacceptably high. Two vasodilators, inhaled prostacyclin and inhaled nitric oxide, are reviewed in this article. ⋯ Currently, only randomized controlled trials exist for inhaled nitric oxide in acute respiratory distress syndrome patients. Randomized controlled trials with consistent dosing methods are needed for both vasodilators to better define their role in the treatment of acute respiratory distress syndrome.
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Acute respiratory distress syndrome remains one of the most clinically vexing problems in critical care. As technology continues to evolve, it is likely that extracorporeal CO(2) removal devices will become smaller, more efficient, and safer. As the risk of extracorporeal support decreases, devices' role in acute respiratory distress syndrome patients remains to be defined. This article discusses the functional properties and management techniques of CO(2) removal and intracorporeal membrane oxygenation and provides a glimpse into the future of long-term gas-exchange devices.
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Critical care clinics · Jul 2011
ReviewExperimental models and emerging hypotheses for acute lung injury.
Acute lung injury (ALI) involves the activation of multiple pathways leading to lung injury, resolution, and repair. Exploration of the roles of individual pathways in humans and animal models has led to a greater understanding of the complexity of ALI and the links between ALI and systemic multiorgan failure. However, there is still no integrated understanding of the initiation, the progression, and the repair of ALI. A better understanding is needed of how pathways interact in the human ALI syndrome and how complementary treatments can be used to modify the onset, severity, and outcome of ALI in humans.
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Critical care clinics · Jul 2011
ReviewGlucocorticoid treatment in acute lung injury and acute respiratory distress syndrome.
Experimental and clinical evidence show a strong association between dysregulated systemic inflammation and progression of acute respiratory distress syndrome (ARDS). This article reviews eight controlled studies evaluating corticosteroid treatment initiated before day 14 of ARDS. ⋯ This low-cost highly effective therapy is well-known, and has a low-risk profile when secondary prevention measures are implemented. The authors recommend prolonged methylprednisolone at 1 mg/kg/d initially in early ARDS, increasing to 2 mg/kg/d after 7 to 9 days of no improvement.
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Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are characterized by acute respiratory failure and are associated with diverse disorders. Gene therapy is a potentially powerful approach to treat diseases related to ALI/ARDS, and numerous viral and nonviral methods for gene delivery to the lung have been developed. Discussed are recent advances in the development of more efficient viral and nonviral gene transfer systems, and the current status of gene therapy applied to ALI/ARDS-associated pulmonary diseases is reviewed. With the development of more efficient gene therapy vectors, gene therapy is a promising strategy for clinical application.