Therapeutic strategies for severe acute lung injury.
Therapeutic strategies for severe acute lung injury.
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DOI：
10.1097/ccm.0b013e3181e795ee
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发表时间：
2010-08
影响因子：
8.8
通讯作者：
Matthay MA
中科院分区：
文献类型：
--
作者：
Diaz JV;Brower R;Calfee CS;Matthay MA
In the management of patients with severe Acute Lung Injury and the Acute Respiratory Distress Syndrome (ALI/ARDS), clinicians are sometimes challenged to maintain acceptable gas exchange while avoiding harmful mechanical ventilation practices. In some of these patients, physicians may consider the use of “rescue therapies” to sustain life. Our goal is to provide a practical, evidence-based review to assist critical care physicians’ care for patients with severe ALI/ARDS. We searched the Pub Med database for clinical trials examining the use of the following therapies in ALI/ARDS: recruitment maneuvers, high positive end expiratory pressure, prone position, high frequency oscillatory ventilation, glucocorticoids, inhaled nitric oxide, buffer therapy and extracorporeal life support. All clinical trials that included patients with severe ALI/ARDS were included in the review. The primary author reviewed the aforementioned trials in depth and then disputed findings and conclusions with other authors until consensus was achieved. This article is designed to: a) provide clinicians with a simple, bedside definition for the diagnosis of severe ARDS; b) describe several therapies that can be used in severe ARDS with an emphasis on the potential risks as well as the indications and benefits; and c) to offer practical guidelines for implementation of these therapies.
