Current drug targets
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Current drug targets · Jul 2004
ReviewIs surfactant a promising additive drug in ALI/ARDS-patients?
The rationale for surfactant replacement therapy in patients with acute respiratory distress syndrome (ARDS) is to restore the normal composition of the surfactant system, as well as to overcome ongoing inactivation of present surfactant. Indeed, surfactant replacement therapy can normalize the composition of the surfactant system and restore its surface activity, which results in restoration of the gas exchange. Several phase II- and phase III-studies have been performed to investigate safety and efficacy of surfactant replacement therapy in patients with ARDS. In this manuscript we will discuss the differences in the composition of exogenous surfactant, the diverse modes of delivery of surfactant, and timing of therapy, in relation to the efficacy of surfactant instillation in several published and yet unpublished studies.
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In last years an increasing number of evidences has been gained that inflammatory response plays a major role in critical illness. The acronym SIRS (Systemic Inflammatory Response Syndrome) has been introduced to define the condition in which the inflammatory reaction exceeds local mechanisms of containment and inflammatory mediators invade the bloodstream causing systemic disturbances. ⋯ Recently, however, some new studies have suggested that corticosteroids given at dosages lower than those initially tested, could positively affect late stages of ARDS by preventing pulmonary fibrosis, and septic shock by improving hemodynamics and facilitating the weaning from catecholamines. To date, it is not clear whether these effects are related to the correction of an adrenocortical dysfunction.