Current opinion in critical care
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Curr Opin Crit Care · Feb 2014
ReviewPharmacological therapies for acute respiratory distress syndrome.
Despite recent advances in the management of patients with acute respiratory distress syndrome (ARDS) by using protective ventilator strategies, the mortality rate of ARDS remains high. The complexity of the pathogenesis and the heterogeneity of coexisting diseases in patients with ARDS require critical care physicians and researchers to search for multiple therapeutic approaches in order to further improve patient outcome. This review article therefore focuses on the recent studies in the field of pharmacological intervention in ARDS. ⋯ Overall, there is no proven pharmacological therapy in ARDS, but some pharmacological interventions were associated with beneficial effects in certain subgroups of patients depending on the cause, underlying diseases, the concurrent supportive therapies and timing. Further clinical trials are warranted to assess multiple outcome measurement of the promising pharmacological interventions in selected patients with ARDS.
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Curr Opin Crit Care · Feb 2014
ReviewSpontaneous breathing in mild and moderate versus severe acute respiratory distress syndrome.
This review summarizes the most recent clinical and experimental data on the impact of spontaneous breathing in acute respiratory distress syndrome (ARDS). ⋯ Clinical and experimental studies show that controlled mechanical ventilation with muscle paralysis in the early phase of severe ARDS reduces lung injury and even mortality. At present, spontaneous breathing should be avoided in the early phase of severe ARDS, but considered in mild-to-moderate ARDS.
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Curr Opin Crit Care · Feb 2014
ReviewHigh-frequency oscillatory ventilation for early acute respiratory distress syndrome in adults.
High-frequency oscillatory ventilation (HFOV) has been considered a potentially ideal mode of lung-protective ventilation. A recent meta-analysis suggested improved oxygenation and reduced mortality in adults and children with acute respiratory distress syndrome (ARDS), but the use of outdated control strategies and small numbers of patients in many of the studies rendered these findings hypothesis-generating only. ⋯ The OSCILLATE and OSCAR trials showed that the early application of HFOV in moderate-to-severe adult ARDS does not reduce mortality compared with conventional ventilation strategies. Future studies on HFOV will need to identify those patients who might benefit most from HFOV and to determine the best oscillator settings. Both goals require an improved capability of monitoring recruitment and overdistension, and oscillatory volumes.
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Curr Opin Crit Care · Feb 2014
ReviewWhat is the future of acute respiratory distress syndrome after the Berlin definition?
To analyze recently published articles in the medical literature that studied distinct aspects of adult patients with acute respiratory distress syndrome (ARDS) after the new Berlin definition introduced in 2012. ⋯ The impact of the Berlin definition of ARDS on the incidence, better treatment stratification and mortality ratio of ARDS is still to be determined.
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Curr Opin Crit Care · Feb 2014
ReviewLung recruitment in acute respiratory distress syndrome: what is the best strategy?
Supporting patients with acute respiratory distress syndrome (ARDS) using a low tidal volume strategy is a standard practice in the ICU. Recruitment maneuvers can be used to augment other methods, like positive end-expiratory pressure and positioning, to improve aerated lung volume. Clinical practice varies widely, and optimal method and patient selection for recruitment maneuvers have not been determined. ⋯ As a component of ventilation strategy for patients with ARDS, the use of recruitment maneuvers, especially a stepwise maneuver, in addition to adequate positive end-expiratory pressure and appropriate positioning, is suggested by currently available data. Until their effect on clinical outcomes is further defined, the use of recruitment maneuvers in ARDS and other settings will continue to be guided by individual clinician experience and patient factors.