Acute respiratory distress syndrome treatment

Acute respiratory distress syndrome treatment Adrenergic (sympathomimetic) compounds Adrenergic (sympathomimetic) receptor blocking agents... 

In low doses, inhaled NO may have a beneficial therapeutic effect, since NO in the inspired air leads to pulmonary vasodilation. In persistent pulmonary hypertension of the newborn, NO inhalation has already been used with some success. NO inhalation as the treatment for acute respiratory distress syndrome, however, has been disappointing. Only transient improvements of oxygenation were detected and the outcome of placebo-controlled trials did not show any improvement... 

Treatment of acute respiratory distress syndrome (ARDS), lipoprotein-releasing activity, in biomaterials as nonthrom-bogenic surfaces Inhibitor of human immunodeficiency virus (HIV) binding to T-lymphocytes 1, 30-31... 

Conversely, the role of perfluorocarbons for oxygen transport and in vivo delivery is investigated. In addition to possible use as temporary blood substitute, these fluorocarbon molecules can be applied as respiratory gas carriers, for instance as lung surfactant replacement compositions for neonates and possibly for the treatment of acute respiratory distress syndrome for adults. Another... 

An 80-year-old woman with dementia accidentally took about 200 ml of chlorhexidine gluconate 5%. She aspirated her gastric contents and despite intensive treatment died of acute respiratory distress syndrome 12 hours later. The serum concentration of chlorhexidine gluconate was markedly high (25 pg/ml). 

The ARDS Network. Ketoconazole for early treatment of acute lung injury and acute respiratory distress syndrome a randomized controlled trial. JAMA 2000 283(15) 1995-2002. 

Delayed reactions are defined by the occurrence of arthralgia and joint stiffness (that is a serum sicknesslike reaction) in the days after infliximab administration they have mostly been observed in patients with Crohn s disease who have received episodic treatment. In one patient the complication was associated with acute respiratory distress syndrome, which only became evident 10 days after re-treatment (22). 

The efficacy of ketoconazole 400 mg qds in the early treatment of acute lung injury and acute respiratory distress syndrome has been investigated in a randomized, double-blind, placebo-controlled trial in 234 patients (2). Ketoconazole was safe but had no effects on mortality, lung function, or the duration of mechanical ventilation. 

Multiple studies have addressed the role of thyroid supplementation in critically ill patients with cardiac disease, sepsis, pulmonary disease (e.g., acute respiratory distress syndrome), or severe infection, or with burn and trauma patients. In spite of a very large number of published studies, it is very difficult to form clear recommendations for treatment with thyroid hormone in the intensive care unit. 

Treatment of acute respiratory distress syndrome (ARDS) or acute lung injury may be defined as a condition involving impaired oxygenation. The nonpharmacologic therapies include mechanical ventilation. The pharmacologic therapies include the use of exogenous surfactant, corticosteroids, acetylcysteine (antioxidant), ketoconazole, nitric oxide, eicosanoids and their inhibitors, sodium nitroprus-side (vasodilator), pentoxifylline, antiendotoxin, and anticytokine therapy and antibiotics. 

In contrast, drugs that release endogenous nitric oxide and donors of the molecule were in use long before nitric oxide was discovered and continue to be very important in clinical medicine. The cardiovascular applications of nitroprusside (Chapter 11) and the nitrates and nitrites (Chapter 12) have been discussed. The treatments of preeclampsia and of pulmonary hypertension and acute respiratory distress syndrome are currently under clinical investigation. Early results from the pulmonary disease studies appear promising, and one preparation of nitric oxide gas (INOmax) has been approved for use in neonates with hypoxic respiratory failure. 

Meduri GU, Kanangat S. Glucocorticoid treatment of sepsis and acute respiratory distress syndrome time for a critical reappraisal [editorial comment]. Grit Care Med 1998 26 630-633. 

Elevated levels of MMPs have been implicated in the pathophysiology of various lung diseases, including acute respiratory distress syndrome, bronchiectasis, and cystic fibrosis (V2). MMPs, EMMPRIN, and TIMPs are produced by many of the resident cells in the lung, hence complicating the analysis of their role in disease (F5, F6, FI2). Potential use of MMP inhibitors for treatment of these disorders remains to be explored. 

Indications for renal replacement therapy in the acute setting and for other disease processes are different from those for ESRD. A common mode of ESRD therapy in the outpatient setting is intermittent hemodialysis (IHD) where a patient receives intense treatment over the course of a few hours several times a week. Acute renal failure in the inpatient setting is often treated with continuous renal replacement therapy (CRRT), which is applied for the entire duration of the patient s clinical need and relies upon hemofiltration to a higher degree than IHD (Meyer, 2000). Other nonrenal indications for CRRT are based on the theoretical removal of inflammatory mediators or toxins and elimination of excess fluid (Schetz, 1999). These illnesses include sepsis and systemic inflammatory response syndrome, acute respiratory distress syndrome, congestive heart failure with volume overload, tumor lysis syndrome, crush injury, and genetic metabolic disturbances (Schetz, 1999). 

Acute exacerbations of IPF are characterized by rapid development of cough, dyspnea, hypoxemia, and worsening pulmonary infiltrates in patients with known IPF (29,148-151). Presentation is similar to acute respiratory distress syndrome (ARDS) (29,148,149,151,152). The cardinal histological feature is DAD superimposed on a background of UIP (149,151). Idiopathic acute interstitial pneumonia (AIP) (28,152) exhibits similar clinical and histological features as acute exacerbations of IPF, but lacks the requisite features of UIP. High-dose intravenous (IV) pulse methylprednisolone has been used to treat acute exacerbations of IPF, but data on treatment are limited to anecdotal cases and small series (29,148,149,151). This entity is reviewed in chapter 15 and will not be further discussed here. 

Meduri GU, Tolley EA, Chrousos GP, et al. Prolonged methylprednisolone treatment suppresses systemic inflammation in patients with unresolving acute respiratory distress syndrome. Am J Respir Crit Care Med 2002 165(7) 983-991. 

Casualties should be admitted and observed for at least 6 hours initially if symptoms persist past the period of exposure, particularly those with pre-existing respiratory disease, or smokers. No specific antidote to chlorine is available and treatment is generally supportive with close monitoring for signs of respiratory compromise, pulmonary oedema and secondary sepsis or acute respiratory distress syndrome (ARDS). 

Wheeler, A.P. et al. 2006. National heart, lung, and blood institute acute respiratory distress syndrome (ARDS) clinical trials network. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med 354 2213-24. 

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