Rescue therapy for refractory ARDS should be offered early: no

Brodie, Daniel; Guérin, Claude

doi:10.1007/s00134-015-3704-6

Cited by 16 publications

(4 citation statements)

References 16 publications

(13 reference statements)

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“…4 Currently, inhaled pulmonary vasodilators are mostly considered a temporizing agent for more established or invasive therapeutic options in refractory ARDS such as prone positioning, NMBAs, and ECMO. 6,22,23 However, others suggest inhaled pulmonary vasodilating agents should not be considered at all or at least not within the early course of ARDS. 5 Despite discordant expert opinions, over 40% of patients with refractory hypoxemia are administered inhaled vasodilators in contemporary clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Fixed-Dose Inhaled Epoprostenol and Inhaled Nitric Oxide for Acute Respiratory Distress Syndrome in Critically Ill Adults

Buckley

Agarwal

Garcia-Orr

et al. 2020

J Intensive Care Med

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Purpose: Several reports have demonstrated similar effects on oxygenation between inhaled epoprostenol (iEPO) compared to inhaled nitric oxide (iNO) for acute respiratory distress syndrome (ARDS). Previous studies directly comparing oxygenation and clinical outcomes between iEPO and iNO exclusively in an adult ARDS patient population utilized a weight-based dosing strategy. The purpose of this study was to compare the clinical and economic impact between iNO and fixed-dosed iEPO for ARDS in adult intensive care unit (ICU) patients. Methods: This retrospective cohort study was conducted at a major academic medical center between January 1, 2014, and October 31, 2018. Patients ≥18 years of age with moderate-to-severe ARDS were included. The primary end point was to compare the mean change in partial arterial oxygen pressure to fraction of inspired oxygen (Pao 2: Fio 2) at 4 hours from baseline between iEPO and iNO. Other secondary aims were total acquisition drug costs, in-hospital mortality, ICU and hospital length of stay, and duration of mechanical ventilation. Results: A total of 239 patients were included with 139 (58.2%) and 100 (41.8%) in the iEPO and iNO groups, respectively. The mean change in Pao 2: Fio 2 at 4 hours from baseline in the iEPO and iNO groups were 31.4 ± 54.6 and 32.4 ± 42.7 mm Hg, respectively ( P = .88). The responder rate at 4 hours was similar between iEPO and iNO groups (64.7% and 66.0%, respectively, P = .84). Clinical outcomes including mortality, overall hospital and ICU length of stay, and mechanical ventilation duration were similar between iEPO and iNO groups. Estimated annual cost-savings realized with iEPO was USD1 074 433. Conclusion: Fixed-dose iEPO was comparable to iNO in patients with moderate-to-severe ARDS for oxygenation and ventilation parameters as well as clinical outcomes. Significant cost-savings were realized with iEPO use.

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Section: Discussionmentioning

confidence: 99%

Comparison of Fixed-Dose Inhaled Epoprostenol and Inhaled Nitric Oxide for Acute Respiratory Distress Syndrome in Critically Ill Adults

Buckley

Agarwal

Garcia-Orr

et al. 2020

J Intensive Care Med

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“…However, it should be considered in patients with refractory hypoxemia (PaO 2 :FiO 2 <80) or acidemia (pH <7.15) despite other less-invasive therapies. 94 Inhaled pulmonary vasodilators are considered salvage therapy since the clinical significance of these agents remains unknown. However, these agents may be considered early in moderate-to-severe ARDS as a temporizing bridge to more invasive therapies.…”

Section: Summary Of Ards Management Strategiesmentioning

confidence: 99%

“…However, these agents may be considered early in moderate-to-severe ARDS as a temporizing bridge to more invasive therapies. 94 Finally, the role of corticosteroids in ARDS remains extremely controversial as a resulting of conflicting efficacy data. Although this therapy may be considered in patients failing previously described strategies, caution of widespread use is warranted since corticosteroids may be detrimental in certain patient populations (ie, influenza pneumonia ARDS).…”

Section: Summary Of Ards Management Strategiesmentioning

confidence: 99%

Moderate to Severe Acute Respiratory Distress Syndrome Management Strategies: A Narrative Review

Buckley

Dzierba

Muir

et al. 2019

Journal of Pharmacy Practice

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Acute respiratory distress syndrome (ARDS) remains a common complication associated with significant negative outcomes in critically ill patients. Lung-protective mechanical ventilation strategies remain the cornerstone in the management of ARDS. Several therapeutic options are currently available including fluid management, neuromuscular blocking agents, prone positioning, extracorporeal membrane oxygenation, corticosteroids, and inhaled pulmonary vasodilating agents (prostacyclins and nitric oxide). Unfortunately, an evidence-based, standard-of-care approach in managing ARDS beyond lung-protective ventilation remains elusive, contributing to significant variability in clinical practice. Although the optimal therapeutic strategy for managing moderate to severe ARDS remains extremely controversial, therapies supported with more robust clinical evidence should be considered first. The purpose of this narrative review is to discuss the published clinical evidence for both pharmacologic and nonpharmacologic management strategies in adult patients with moderate to severe ARDS as well as to discuss practical considerations for implementation.

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“…In light of the significant mortality benefit seen with the use of prone positioning in patients with ARDS (25), prone positioning should be strongly considered prior to the initiation of ECMO, when possible (59). Prone positioning might also be considered in selected patients managed with ECMO.…”

Section: Ventilator Strategiesmentioning

confidence: 99%

Extracorporeal techniques in acute respiratory distress syndrome

2017

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Extracorporeal membrane oxygenation (ECMO) was first introduced for patients with acute respiratory distress syndrome (ARDS) in the 1970s. However, enthusiasm was tempered due to the high mortality seen at that time. The use of ECMO has grown considerably in recent years due to technological advances and the evidence suggesting potential benefit. While the efficacy of ECMO has yet to be rigorously demonstrated with high-quality evidence, it has the potential not only to have a substantial impact on outcomes, including mortality, but also to change the paradigm of ARDS management.

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Rescue therapy for refractory ARDS should be offered early: no

Cited by 16 publications

References 16 publications

Comparison of Fixed-Dose Inhaled Epoprostenol and Inhaled Nitric Oxide for Acute Respiratory Distress Syndrome in Critically Ill Adults

Comparison of Fixed-Dose Inhaled Epoprostenol and Inhaled Nitric Oxide for Acute Respiratory Distress Syndrome in Critically Ill Adults

Moderate to Severe Acute Respiratory Distress Syndrome Management Strategies: A Narrative Review

Extracorporeal techniques in acute respiratory distress syndrome

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