Nonventilatory treatments for acute lung injury and ARDS
Nonventilatory treatments for acute lung injury and ARDS
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DOI：
10.1378/chest.06-1743
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发表时间：
2007-03-01
期刊：
影响因子：
9.6
通讯作者：
Matthay, Michael A.
中科院分区：
文献类型：
--
作者：
Calfee, Carolyn S.;Matthay, Michael A.
在过去的十年中，急性肺损伤 (ALI) 和 ARDS 通气管理方面的进步改善了预后；然而，直到最近，对其他疗法的探索还没有取得什么成果。最近，急性呼吸窘迫综合征网络液体和导管治疗试验报告称，与自由液体策略相比，保守液体管理策略增加了 ALI 患者的平均 (+/- SE) 无呼吸机天数（分别为 14.6 +/- 0.5 与 12.1 +/- 0.5 天；p < 0.001）。除了对结果产生有益影响外，研究发现保守液体策略不会增加肾衰竭或休克的发生率。其他研究表明，白蛋白和呋塞米治疗可能对肺损伤的低蛋白血症患者有益，但仍缺乏结果数据。尽管皮质类固醇、表面活性剂和一氧化氮等几种药物疗法已被证明对改善结果无效，但正在进行或即将进行的临床试验正在研究几种有希望的新疗法。本文回顾了有关 ALI 患者最佳非通气治疗的这些进展和其他最新研究。
Over the past decade, advances in the ventilatory management of acute lung injury (ALI) and ARDS have improved outcomes; however, until recently the search for other therapies has been less fruitful. Recently, the Acute Respiratory Distress Syndrome Network Fluid and Catheter Treatment Trial reported that a conservative fluid management strategy, compared with a fluid liberal strategy, increased the mean (+/- SE) number of ventilator-free days in patients with ALI (14.6 +/- 0.5 vs 12.1 +/- 0.5 days, respectively; p < 0.001). In addition to this beneficial effect on outcomes, the study found that the conservative fluid strategy did not increase the incidence of renal failure or the development of shock. Other studies have demonstrated that albumin and furosemide therapy may be beneficial in hypoproteinemic patients with lung injury, though data on outcomes is still lacking. Although several pharmacologic therapies, such as corticosteroids, surfactant, and nitric oxide, have been demonstrated to be ineffective in improving outcomes, several promising new treatments are being investigated in ongoing or upcoming clinical trials. This article reviews these developments and other recent research on the optimal nonventilatory management of patients with ALI.