Clinical Practice Guideline of Acute Respiratory Distress Syndrome

Cho, Young-Jae; Moon, Jae Young; Shin, Ein Soon; Kim, Je Hyeong; Jung, Hoon; Park, So Young; Kim, Ho Cheol; Sim, Yun Su; Rhee, Chin Kook; Lim, Jae‐Min; Lee, Won Yeon; Lee, Hyun Jeong; Kwak, Sang Hyun; Kang, Eun Kyeong; Chung, Kyung Soo; Choi, Won-Il

doi:10.4266/kjccm.2016.31.2.76

Cited by 15 publications

(13 citation statements)

References 155 publications

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Section: Discussionmentioning

confidence: 99%

“…There are several clinical guidelines for the management of ARDS with conflicting recommendations [25][26][27][28]. Korean and Scandinavian guidelines recommended against routine corticosteroid use because there was no significant survival benefit of corticosteroids [25,26]. In the Japanese guideline, corticosteroid use was suggested because the corticosteroid therapy was associated with a decreased duration of mechanical ventilation and did not significantly increase the infection rate [28].…”

Section: Discussionmentioning

confidence: 99%

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Effect of corticosteroid therapy in the early phase of acute respiratory distress syndrome: a propensity-matched cohort study

Baek

Lee

Hong

et al. 2021

Korean J Intern Med

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Background/Aims: It is unclear whether corticosteroid use in patients with acute respiratory distress syndrome (ARDS) improves survival. This study aimed to investigate whether the administration of corticosteroids to patients in the early phase of moderate to severe ARDS is associated with improved outcomes. Methods: We analyzed the data of patients who received corticosteroids within 7 days of the onset of ARDS between June 2006 and December 2015 at a single tertiary teaching hospital. A total of 565 patients admitted with moderate to severe ARDS were eligible. The outcomes of patients treated with methylprednisolone 40 to 180 mg/day or equivalent (n = 404) were compared to those who did not receive steroids (n = 161). The primary and secondary outcomes were 28-and 90-day mortality rates, respectively. Propensity scores were used to adjust for baseline covariates. Results: The overall mortality at 28 days was not significantly different between the corticosteroid-treated and control groups (43.8% vs. 41%, p = 0.541). At 90 days, the overall mortality rate was higher in the corticosteroid-treated group than in the control group (59.2% vs. 48.4%, p = 0.021). However, on propensity score matching, corticosteroid therapy was not associated with a higher 28-day mortality rate (odds ratio, 1.031; 95% confidence interval, 0.657 to 1.618; p = 0.895) and 90 days (odds ratio, 1.435; 95% confidence interval, 0.877 to 2.348; p = 0.151). Conclusions: Corticosteroid therapy was not associated with 28-or 90-day mortality in the early phase of moderate to severe ARDS on propensity score matching analysis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of corticosteroid therapy in the early phase of acute respiratory distress syndrome: a propensity-matched cohort study

Baek

Lee

Hong

et al. 2021

Korean J Intern Med

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“…6,7 Although there have been a number of therapeutic interventions recognized over the past couple of years, the occurrence of ALI cases has increased from approximately 1.5 to 75 cases per a 100 000 population, while the mortality of patients diagnosed with ARDS has reached 40%. 8,9 Based on this information, urgency in in discovering newer and more accurate biomarkers is imminent in order to help provide a better diagnosis along with a positive prognosis of ALI.…”

mentioning

confidence: 99%

Protective effects of the suppressed NF‐κB/TLR4 signaling pathway on oxidative stress of lung tissue in rat with acute lung injury

Zhang

Wang

Chen

et al. 2019

The Kaohsiung J of Med Scie

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The pathogenesis of acute lung injury (ALI) is characterized by lung inflammation and lung oxidative stress. The study was conducted in order to investigate the effect toll‐like receptor 4 (TLR4) and nuclear factor‐kappa B (NF‐κB) exhibited on oxidative stress in ALI. After the rats had been assigned into different groups, arterial blood, white blood cell (WBC), lung permeability index (LPI), wet/dry (W/D) ratio, TLR4 and NF‐κB expression and superoxide dismutase (SOD), myeloperoxidase (MPO), malondialdehyde (MDA), glutathione (GSH), and reactive oxygen species (ROS) were examined. Afterward, the correlation between the levels of TLR4 and NF‐κB was determined. Decreased levels of PaO2, SOD, MPO, and GSH accompanied by increased levels of PaCO2, WBC number, LPI and W/D ratio, MDA and ROS, as well as TLR4 and NF‐κB expressions in the ALI, ALI + NF‐κB inhibitor, and ALI + phosphate buffer saline groups were found. Inhibition of NF‐κB resulted in increased PaO2 and decreased PaCO2 levels, WBC number, and LPI and W/D ratio. Decreased expression of NF‐κB increased SOD, GSH, and MPO, but decreased MDA and ROS. We also found that NF‐κB inhibition resulted in the improvement of ALI in rats. TLR4 and NF‐κB expressions were negatively correlated with levels of SOD, MPO, and GSH, and positively correlated with MDA and ROS levels. In summary, our findings provided evidence that inhibition of the TLR4/NF‐κB signaling pathway decreases oxidative stress, thereby improving ALI. As a result, NF‐κB signaling pathway has shown potential as a therapeutic target in ALI therapy.

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“…This "lung-protective" strategy incorporates low tidal volume (VT) ventilation and low airway plateau pressure (Pplat) with permissive hypercapnia, if needed. Experimental studies demonstrated a 9% absolute mortality reduction in a group of patients randomized to receive 6ml/kg (predicted body weight) VT and Pplat less than 30cmH 2 O compared with 12ml/kg VT and Pplat less than 50cmH 2 O [13].…”

Section: General Guidelines For Ventilator Managementmentioning

confidence: 98%

Evaluating mechanical ventilation in patients with Acute Respiratory Distress Syndrome

Grigorakos¹

2018

Arch Pulmonol Respir Care

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Even though acute respiratory distress syndrome (ARDS) has been intensively and continuously studied in various settings, its mortality remains high. Mechanical ventilation is an essential component of the care of patients with ARDS. Thus, many randomized controlled clinical trials have been conducted, evaluating the effi cacy and safety of various methods of mechanical ventilation in order to adapt ventilatory setting to protect patients from ventilator-induced lung injury (VILI) and to treat them effectively. There is no well-stated practical guideline for mechanically ventilated patients with or without ARDS. However, as general measures low tidal volume, high positive end-expiratory pressure, and conservative fl uid therapy seem to improve outcomes. In conclusion, improving knowledge and evidence regarding the management of mechanically ventilated ARDS patients is critical. Thus, medical personnel managing patients with ARDS should personalize decisions for their patients.

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Clinical Practice Guideline of Acute Respiratory Distress Syndrome

Cited by 15 publications

References 155 publications

Effect of corticosteroid therapy in the early phase of acute respiratory distress syndrome: a propensity-matched cohort study

Effect of corticosteroid therapy in the early phase of acute respiratory distress syndrome: a propensity-matched cohort study

Protective effects of the suppressed NF‐κB/TLR4 signaling pathway on oxidative stress of lung tissue in rat with acute lung injury

Evaluating mechanical ventilation in patients with Acute Respiratory Distress Syndrome

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