Prone Positioning and Neuromuscular Blocking Agents as Adjunctive Therapies in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome

Guérin, Claude; Cour, Martin; Argaud, Laurent

doi:10.1055/s-0042-1744304

Cited by 2 publications

(2 citation statements)

References 84 publications

(111 reference statements)

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“…In the face of the high incidence of ARDS in the three outbreaks, several ventilation interventions such as tidal volume reduction [ 30 ], positive end-expiratory pressure (PEEP) [ 31 ], and adjunctive measures such as prone position, neuromuscular block [ 32 ], and extracorporeal membrane oxygenation (ECMO) have been proposed [ 33 ]. Although treatment strategies such as protective mechanical ventilation techniques have reduced the risk of death in patients with ARDS, current pharmacotherapy for ADRS has been poorly treated for a long time.…”

Section: Dicussionmentioning

confidence: 99%

Effect of Sivelestat in the Treatment of Acute Lung Injury and Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

Ding,

Wang,

Yang

et al. 2023

Intensive Care Res

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Background The efficacy of neutrophil elastase inhibitor sivelestat in the treatment of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) remains controversial. A systematic review and meta-analysis were performed in accordance with the PRISMA guidelines assess the effect of sivelestat on ALI/ARDS patients, different studies were included. Methods Electronic databases, National Knowledge Infrastructure (CNKI), Wan fang data, VIP, PubMed, Embase, Springer, Ovid and the Cochrane Library were searched using the following key words: (“Sivelestat” OR “Elaspol”) AND (“ARDS” OR “adult respiratory distress syndrome” OR “acute lung injury”). All databases published from January 2000 to August 2022. The treatment group was treated with sivelestat and the control group was given normal saline. The outcome measurements include the mortality of 28–30 days, mechanical ventilation time, ventilation free days, intensive care unit (ICU) stays, oxygenation index (PaO2/FiO2) on day 3, the incidence of adverse events. The literature search was conducted independently by 2 researchers using standardized methods. We used the Cochrane risk-of-bias tool to assess the quality of the included studies. Mean difference (MD), Standardized mean difference (SMD) and relative risk (RR) were calculated using random effects model or fixed effects model. All statistical analyses were performed using RevMan software 5.4. Results A total of 2050 patients were enrolled in 15 studies, including 1069 patients in treatment group and 981 patients in the control group. The results of the meta-analysis showed that: compared with the control group, sivelestat can reduce the mortality of 28–30 days (RR = 0.81, 95% CI = 0.66–0.98, p = 0.03) and the incidence of adverse events (RR = 0.91, 95% CI = 0.85–0.98, p = 0.01), shortened mechanical ventilation time (SMD = − 0.32, 95% CI = − 0.60 to − 0.04, p = 0.02) and ICU stays (SMD = − 0.72, 95% CI = − 0.92 to − 0.52, p < 0.00001), increased the ventilation free days (MD = 3.57, 95% CI = 3.42–3.73, p < 0.00001) and improve oxygenation index (PaO2/FiO2) on day 3 (SMD = 0.88, 95% CI = 0.39–1.36, p = 0.0004). Conclusions Sivelestat can not only reduce the mortality of ALI/ARDS patients within 28–30 days and the incidence of adverse events, shorten the mechanical ventilation time and ICU stays, increase ventilation free days, but also improve the oxygenation index of patients on days 3, which has a good effect on the treatment of ALI/ARDS. These findings need to be verified in large-scale trials.

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Section: Dicussionmentioning

confidence: 99%

Effect of Sivelestat in the Treatment of Acute Lung Injury and Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

Ding,

Wang,

Yang

et al. 2023

Intensive Care Res

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“…From severe acute respiratory syndrome (SARS) in 2003, to middle east respiratory syndrome (MERS) in 2012, to coronavirus pneumonia (COVID- 19) in the winter of 2019, the incidence of ARDS in these three outbreaks was 20%, 20-30%, and 18-30%, respectively [2]. A number of ventilatory interventions, such as lower tidal volumes [3], higher positive end-expiratory pressure (PEEP) [4], and adjuncts such as prone positioning, neuromuscular blockade [5], and extracorporeal membrane oxygenation [6] for ARDS have been proposed. These supportive treatments that provide protective lung ventilation are designed to give patients a chance to repair their lungs.…”

Section: Introductionmentioning

confidence: 99%

Clinical Utility of the Sivelestat for the Treatment of ALI/ARDS: Moving on in the Controversy?

et al. 2022

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Acute respiratory distress syndrome (ARDS) is a serious condition that can arise following direct or indirect acute lung injury (ALI). It is heterogeneous and has a high mortality rate. Supportive care is the mainstay of treatment and there is no definitive pharmacological treatment as yet. In nonclinical studies, neutrophil elastase inhibitor sivelestat appears to show benefit in ARDS without inhibiting the host immune defense in cases of infection. In clinical studies, the efficacy of sivelestat in the treatment of ARDS remains controversial. The currently available evidence suggests that sivelestat may show some benefit in the treatment of ARDS, although large, randomized controlled trials are needed in specific pathophysiological conditions to explore these potential benefits.

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Prone Positioning and Neuromuscular Blocking Agents as Adjunctive Therapies in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome

Cited by 2 publications

References 84 publications

Effect of Sivelestat in the Treatment of Acute Lung Injury and Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

Effect of Sivelestat in the Treatment of Acute Lung Injury and Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

Clinical Utility of the Sivelestat for the Treatment of ALI/ARDS: Moving on in the Controversy?

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