Aerosolized prostacyclin for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)

Afshari, Arash; Brok, Jesper; Møller, Ann Merete; Wetterslev, Jørn

doi:10.1002/14651858.cd007733

Cited by 5 publications

(3 citation statements)

References 37 publications

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“…Other therapies, including the use of nitric oxide [37], prostacyclin [38] and surfactant [39], have been investigated and found to be ineffective. These additional therapies, plus others, are beyond the scope of this review, but have been covered in recent review articles [40,41]…”

Section: Introductionmentioning

confidence: 99%

Pharmacological treatments in ARDS; a state-of-the-art update

Boyle

Sweeney

McAuley

2013

BMC Med

124

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Despite its high incidence and devastating outcomes, acute respiratory distress syndrome (ARDS) has no specific treatment, with effective therapy currently limited to minimizing potentially harmful ventilation and avoiding a positive fluid balance. Many pharmacological therapies have been investigated with limited success to date. In this review article we provide a state-of-the-art update on recent and ongoing trials, as well as reviewing promising future pharmacological therapies in ARDS.

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Section: Introductionmentioning

confidence: 99%

Pharmacological treatments in ARDS; a state-of-the-art update

Boyle

Sweeney

McAuley

2013

BMC Med

124

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“…There are no available strong randomized clinical studies for the effectiveness of inhaled prostaglandins in the treatment of ARDS. One clinical trial, which included 14 critically ill children with ARDS, did not show survival benefits of prostacyclin versus placebo [18]. However, observational studies and case series have shown efficacy of inhaled prostaglandins for improved oxygenation in severe hypoxemia due to ARDS.…”

Section: Discussionmentioning

confidence: 99%

Zinc Chloride Smoke Inhalation Induced Severe Acute Respiratory Distress Syndrome: First Survival in the United States with Extended Duration (Five Weeks) Therapy with High Dose Corticosteroids in Combination with Lung Protective Ventilation

Mahboob

Richeson

McCain

2017

Case Reports in Critical Care

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Zinc chloride smoke bomb exposure is frequently seen in military drills, combat exercises, metal industry works, and disaster simulations. Smoke exposure presents with variety of pulmonary damage based on the intensity of the exposure. Smoke induced severe acute respiratory distress syndrome (ARDS) is often fatal and there are no standard treatment guidelines. We report the first survival of smoke induced severe ARDS in the United States (US) with prolonged use of high dose steroids (five weeks) and lung protective ventilation alone. Previously reported surviving patients in China and Taiwan required extracorporeal membrane oxygenation (ECMO) and other invasive modalities. We suggest that an extended course of high dose corticosteroids should be considered for the treatment of smoke inhalation related ARDS and should be introduced as early as possible to minimize the morbidity and mortality. We further suggest that patients with smoke inhalation should be observed in the hospital for at least 48 to 72 hours before discharge, as ARDS can have a delayed onset. Being vigilant for infectious complications is important due to prolonged steroid treatment regimen. Patients must also be monitored for critical illness polyneuromyopathy. Additionally, upper airway injury should be suspected and early evaluation by otorhinolaryngology may be beneficial.

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“…Routine use of pulmonary vasodilators (such as inhaled nitric oxide and prostacyclins) in ARDS is not recommended since they have not been shown to confer outcome benefit [94–97]. Clinicians, though, tend to use them as ‘salvage’ therapies for refractory hypoxaemia, that is, that which fails to improve with other conventional measures or to ‘buy time’ for the initiation of VV‐ECMO.…”

Section: Other Managementmentioning

confidence: 99%

Invasive mechanical ventilation in patients with acute respiratory distress syndrome receiving extracorporeal support: a narrative review of strategies to mitigate lung injury

et al. 2022

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Veno-venous extracorporeal membrane oxygenation is indicated in patients with acute respiratory distress syndrome and severely impaired gas exchange despite evidence-based lung protective ventilation, prone positioning and other parts of the standard algorithm for treating such patients. Extracorporeal support can facilitate ultra-lung-protective ventilation, meaning even lower volumes and pressures than standard lungprotective ventilation, by directly removing carbon dioxide in patients needing injurious ventilator settings to maintain sufficient gas exchange. Injurious ventilation results in ventilator-induced lung injury, which is one of the main determinants of mortality in acute respiratory distress syndrome. Marked reductions in the intensity of ventilation to the lowest tolerable levels under extracorporeal support may be achieved and could thereby potentially mitigate ventilator-induced lung injury and theoretically patient self-inflicted lung injury in spontaneously breathing patients with high respiratory drive. However, the benefits of this strategy may be counterbalanced by the use of continuous deep sedation and even neuromuscular blocking drugs, which may impair physical rehabilitation and impact long-term outcomes. There are currently a lack of large-scale prospective data to inform optimal invasive ventilation practices and how to best apply a holistic approach to patients receiving veno-venous extracorporeal membrane oxygenation, while minimising ventilator-induced and patient self-inflicted lung injury. We aimed to review the literature relating to invasive ventilation strategies in patients with acute respiratory distress syndrome receiving extracorporeal support and discuss personalised ventilation approaches and the potential role of adjunctive therapies in facilitating lung protection.

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Aerosolized prostacyclin for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)

Cited by 5 publications

References 37 publications

Pharmacological treatments in ARDS; a state-of-the-art update

Pharmacological treatments in ARDS; a state-of-the-art update

Zinc Chloride Smoke Inhalation Induced Severe Acute Respiratory Distress Syndrome: First Survival in the United States with Extended Duration (Five Weeks) Therapy with High Dose Corticosteroids in Combination with Lung Protective Ventilation

Invasive mechanical ventilation in patients with acute respiratory distress syndrome receiving extracorporeal support: a narrative review of strategies to mitigate lung injury

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