New Therapies for ARDS
CHEST JournalPublished 1 August 1995
Leonard D. Hudson
Citations35
SJR quartileQ1
SJR score1.83
SNIP1.83
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Abstract
The therapy for the acute respiratory distress syndrome (ARDS) is complex. It consists of supportive therapy for the acute respiratory failure, but this occurs in a context of treatment of the underlying condition(s) in critically ill or injured patients, often with comorbid conditions and with significant interactions between therapies. Therapy can be divided into that which is supportive, ie, which supports the physiologic abnormalities and returns them toward normal but which has no fundamental effect on the underlying mechanisms of the organ injury, and that which is definitive, ie, which affects the mechanisms of injury. Many new therapies have been proposed in the last several years in both the supportive and definitive aspects of treatment. Virtually none of these has been shown to unequivocally improve mortality in a randomized controlled clinical trial. Despite this, changes in therapy have occurred and the high mortality rates associated with ARDS appear to be decreasing. We recently reported a significant lowering of mortality for patients with ARDS in our institution from greater than 60% to approximately 40% over a 10-year period, using the same definition of ARDS and controlling for important variables known to affect outcome. 1 Milberg JA Davis DR Steinberg KP et al. Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983-93.. JAMA. 1995; 273: 306-309 Crossref PubMed Google Scholar This appears to be true in other institutions as well, as suggested by fatality rates of control groups in controlled trials that are lower than those of historic controls. 2 Morris AH Wallace CJ Meniove RL et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome.. Am J Respir Crit Care Med. 1994; 149: 295-305 Crossref PubMed Google Scholar , 3 Suchyta MR Clemmer TP Orme JF et al. Increased survival of ARDS patients with severe hypoxemia (ECMO criteria).. Chest. 1991; 99: 951-955 Abstract Full Text Full Text PDF PubMed Google Scholar
Keywords
Medicine
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New England Journal of MedicineA Controlled Clinical Trial of High-Dose Methylprednisolone in the Treatment of Severe Sepsis and Septic Shock
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It is concluded that the use of high-dose corticosteroids provides no benefit in the treatment of severe sepsis and septic shock.
JAMAExtracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study
1,223 Citations1979Warren M. Zapol
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1,179 Citations1979Warren M. Zapol
New England Journal of MedicineTreatment of Gram-Negative Bacteremia and Shock with Human Antiserum to a Mutant<i>Escherichia coli</i>
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American Journal of Respiratory and Critical Care MedicineRandomized Clinical Trial of Pressure-Controlled Inverse Ratio Ventilation and Extracorporeal CO2 Removal for Adult Respiratory Distress Syndrome
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It is concluded that there was no significant difference in survival between the mechanical ventilation and the extracorporeal CO2 removal groups, and extracordoreal support for ARDS should be restricted to controlled clinical trials.
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Perioperative increase of oxygen delivery with dopexamine hydrochloride significantly reduces mortality and morbidity in high-risk surgical patients.
PubMedExperimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures. Protection by positive end-expiratory pressure.
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New England Journal of MedicineThe Effects of High-Dose Corticosteroids in Patients with Septic Shock
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703 Citations1987The Veterans Administration Systemic Sepsis Cooperative Study Group*
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701 Citations1994Keith G. Hickling, J. Walsh +2 more
To evaluate the outcome in patients with severe adult respiratory distress syndrome managed with limitation of peak inspiratory pressure to 30 to 40 cm H2O, low tidal volumes, spontaneous breathing using synchronized intermittent mandatory ventilation from the start.
JAMAImproved Survival of Patients With Acute Respiratory Distress Syndrome (ARDS): 1983-1993
696 Citations1995John Milberg
A significant decrease in fatality rates is observed largely in patients younger than 60 years and in those with sepsis syndrome as their risk for ARDS, which should be considered in clinical trials designed to prevent ARDS and the high mortality associated with this syndrome.
JAMALow-Frequency Positive-Pressure Ventilation With Extracorporeal CO2 Removal in Severe Acute Respiratory Failure
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Extracorporeal carbon dioxide removal with low-frequency ventilation proved a safe technique, and it is suggested as a valuable tool and an alternative to treating severe acute respiratory failure by conventional means.
Journal of Clinical InvestigationSurfactant chemical composition and biophysical activity in acute respiratory distress syndrome.
643 Citations1991T J Gregory, William J. Longmore +8 more
Data demonstrate that the chemical composition and functional activity of surfactant is altered in ARDS, suggesting that these abnormalities occur early in the disease process.
American Review of Respiratory DiseaseImproved Outcome Based on Fluid Management in Critically III Patients Requiring Pulmonary Artery Catheterization
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CHEST JournalElevation of Cardiac Output and Oxygen Delivery Improves Outcome in Septic Shock
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American Review of Respiratory DiseaseIneffectiveness of High-dose Methylprednisolone in Preventing Parenchymal Lung Injury and Improving Mortality in Patients with Septic Shock
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This huge book bears testimony to an explosion of knowledge in a field of science that had, until the past quarter century, rested on five Galenic pillars (or Celsus' four, if one would have it simpler) of heat, redness, swelling, pain, and functional loss.
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Journal of Applied PhysiologyChest wall restriction limits high airway pressure-induced lung injury in young rabbits
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PubMedSevere impairment in lung function induced by high peak airway pressure during mechanical ventilation. An experimental study.
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PubMedImproved oxygenation in patients with acute respiratory failure: the prone position.
420 Citations1977W. W. Douglas, Kai Rehder +3 more
Six patients with acute respiratory failure were turned from supine to prone, supporting the upper thorax and pelvis and allowing the abdomen to protrude, and arterial PO2 increased, permitting a decrease in inspired oxygen concentration or positive end-expiratory pressure when prone.
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The cardiorespiratory pattern of the 67 survivors, which to a first approximation represents the optimal therapeutic goals, is described, and these with the patterns of the 31 patients who died are contrasted.
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379 Citations1988Martin Langer, D. Mascheroni +2 more
The gas exchange and hemodynamics were evaluated before, during, and after a two-hour period of prone position in 13 moderate-severe ARDS patients and disappearance of posterobasal densities and appearance of new densities in the anterior regions, in both patients studied.
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American Review of Respiratory DiseaseHistopathologic Pulmonary Changes from Mechanical Ventilation at High Peak Airway Pressures
317 Citations1991K Tsuno, Kazunori Miura +3 more
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Annals of SurgeryMathematic Coupling of Data
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Four types of mathematic coupling of data are identified: direct algebraic coupling between two variables, when one or more of the variables is derived and/or calculated, and indirect coupling or physiologic coupling, which involves directional changes in two variables which are mathematically coupled.
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Journal of Applied PhysiologyEffect of granulocyte depletion in a ventilated surfactant-depleted lung
278 Citations1987Tsuyoshi Kawano, Shuji Mori +5 more
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The Journal of Infectious DiseasesTreatment of Gram-Negative Septic Shock with Human IgG Antibody to Escherichia coli J5: A Prospective, Double-Blind, Randomized Trial
267 Citations1988Thierry Calandra, M. P. Glauser +2 more
Treatment with J5-IVIG did not reduce the number of systemic complications of shock and did not delay the occurrence of death due to septic shock, and it was concluded that J5 -IVIG was not superior to IVIG in reducing mortality or in reversing gram-negative septicshock.
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The improvement of oxygenation by NO inhalation in ARDS does not require reduction of pulmonary resistance and can be performed using low doses in the ppb range, which has to be considered as probably non-toxic.
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CHEST JournalPressure Controlled Inverse Ratio Ventilation in Severe Adult Respiratory Failure
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Annals of SurgeryProstaglandin E1 and Survival in Patients with the Adult Respiratory Distress Syndrome
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Interim guidelines for a ventilatory strategy in patients with ARDS are presented based on the literature and the own clinical experience, and clinicians are using IRV with increasing frequency.
New England Journal of MedicineThe Ethics of the Randomized Clinical Trial
193 Citations1982Arthur Schafer
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192 Citations1983Graziano C. Carlon, William S. Howland +4 more
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CHEST JournalIncreased Survival of ARDS Patients with Severe Hypoxemia (ECMO Criteria)
162 Citations1991Mary R. Suchyta, Terry P. Clemmer +3 more
Survival of ARDS patients who met ECMO blood gas criteria in this institution is higher than that previously reported from both other centers and the authors' own hospital.
Archives of SurgeryIdiopathic Pulmonary Fibrosis in Adult Respiratory Distress Syndrome
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Ten consecutive patients who presented initially with adult respiratory distress syndrome, and who did not respond to conventional treatment, underwent open lung biopsy early in the course of their illness and eight patients survived and have not required long-term corticosteroid therapy.
Critical Care MedicineA double-blind, prospective, randomized trial of ketoconazole, a thromboxane synthetase inhibitor, in the prophylaxis of the adult respiratory distress syndrome
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Ketoconazole (400 mg through the gastrointestinal tract) given early in the septic course may prevent ARDS and decrease the mortality rate in high-risk, septic patients.
The American Journal of MedicineHepatic reactions during ketoconazole treatment
157 Citations1983Paul A. J. Janssen, J. Symoens
Silent and symptomatic hepatic reactions have occurred during ketoconazole treatment and asymptomatic increases in liver enzymes may also occur in a sizeable number of patients with fungal disease without any treatment.
High-Frequency Jet Ventilation
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149 Citations1986Michael J. Gurevitch, John Van Dyke +2 more
Two patients with the adult respiratory distress syndrome were placed on pressure-controlled inverse-ratio ventilation when their condition deteriorated despite optimal treatment with intermittent mandatory ventilation and positive end-expiratory pressure, showing that IRV may offer certain advantages in the treatment of severe ARDS.
CHEST JournalPressure Control Inverse Ratio Ventilation as a Method to Reduce Peak Inspiratory Pressure and Provide Adequate Ventilation and Oxygenation
148 Citations1989David C. Lain, Robert J. DiBenedetto +4 more
It is proposed that PcIRV allows for adequate ventilation and oxygenation with decreases in PIP, extrinsically added PEEP and inspired O2 concentration, which may decrease the morbidity associated with IPPV utilizing high PIP and PEEP.
JAMASafety and Potential Efficacy of an Aerosolized Surfactant in Human Sepsis-Induced Adult Respiratory Distress Syndrome
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CHEST JournalCardiorespiratory Effects of Pressure-controlled Ventilation With and Without Inverse Ratio in the Adult Respiratory Distress Syndrome
132 Citations1993Alain Mercat, L. Graïni +3 more
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CHEST JournalEstablished ARDS Treated with a Sustained Course of Adrenocortical Steroids
129 Citations1990Robert G. Hooper, Robert A. Kearl
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American Review of Respiratory DiseaseEffect of Almitrine on Ventilation-Perfusion Distribution in Adult Respiratory Distress Syndrome
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Almitrine significantly reduced the VA/Q inequalities present in ARDS and may be useful in the management of those patients.
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ResuscitationHemofiltration in septic ards. the artificial kidney as, an artificial endocrine lung
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The data demonstrate that oxygenation is primarily a function of mean airway pressure, and that longer inspiratory times can be used as an alternative to applied PEEP to increase this oxygenation.
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American Journal of Respiratory and Critical Care MedicineMathematical Coupling Explains Dependence of Oxygen Consumption on Oxygen Delivery in ARDS
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PubMedPhysiologic monitoring goals for the critically ill patient.
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The empirically determined median value of the survivors taken in the late stage during periods remote from therapy was found to be a better criterion for therapeutic goals for most variables, including blood flow, oxygen transport and most intravascular pressures.
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It is concluded that pretreatment with G- CSF potentiates ANTU- and HCl-induced lung injury in non-neutropenic rats and the potential for G-CSF to aggravate acute lung Injury in patients remains speculative.
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CHEST JournalEffects of Inverse Ratio Ventilation on Cardiorespiratory Parameters in Severe Respiratory Failure
63 Citations1992Kevin Chan, Edward Abraham
The results demonstrate that inversion of conventional I/E ratios produces no significant improvement in the overall cardiorespiratory profile of critically ill patients and suggests that the clinical utility of PC-IRV is limited except in the setting of the adult respiratory distress syndrome with hypoxemia or hypercapnia refractory to other therapeutic options.
The Journal of Infectious DiseasesFailure of Antisera to J5 and R595 Rough Mutants to Reduce Endotoxemic Lethality
60 Citations1988Sheldon E. Greisman, Craig A. Johnston
Rabbit antisera to J5 (Rc) Escherichia coli and R595 (Re) Salmonella minnesota rough mutants were selected for the highest content of hemagglutinating antibodies to their respective core glycolipids but failed to passively protect ICR or CF-1 mice against lethality induced by endotoxins from a variety of wild-type, smooth enterobacteria.
AnesthesiologyClinical Trials of an Intravenous Oxygenator in Patients with Adult Respiratory Distress Syndrome
60 Citations1992Kane M. High, Michael T. Snider +6 more
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