Critical care clinics
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Critical care clinics · Jul 2011
ReviewSurfactant therapy for acute lung injury and acute respiratory distress syndrome.
This article examines exogenous lung surfactant replacement therapy and its usefulness in mitigating clinical acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). Surfactant therapy is beneficial in term infants with pneumonia and meconium aspiration lung injury, and in children up to age 21 years with direct pulmonary forms of ALI/ARDS. However, extension of exogenous surfactant therapy to adults with respiratory failure and clinical ALI/ARDS remains a challenge. This article reviews clinical studies of surfactant therapy in pediatric and adult patients with ALI/ARDS, focusing on its potential advantages in patients with direct pulmonary forms of these syndromes.
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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.