呼吸窘迫综合征最新病历辩析.ppt

ARDS -- role of ketoconazole Randomized, double-blind, placebo-controlled trial from March 1996 to January 1997 24 hospitals associated with 10 network centers in the United States PATIENTS A total of 234 pts with ALI or ARDS INTERVENTION: ketoconazole, 400 mg/d (n = 117) placebo (n = 117) initiated within 36 hours of fulfilling study entry criteria and given enterally for up to 21 days Ketoconazole – an antifungal with immunomodulatory effect CONCLUSION: In these patients with ALI or ARDS, ketoconazole was safe and bioavailable but did not reduce mortality or duration of mechanical ventilation or improve lung function These data do not support the use of ketoconazole for the early treatment of ALI or ARDS. ARDS -- role of ketoconazole ARDS -- pharmacologic tx Inhaled pulmonary vasodilators nitric oxide ± almitrine PGE1 PGI2 Anti-adhesion molecules Pro-inflammatory approaches (GM-CSF) Surfactant replacement therapy Gene therapy ARDS -- pharmacologic tx Anti-endotoxin immunotherapy monoclonal antibody in patients with sepsis syndrome little or no survival benefit under investigation lipid x bacterial permeability-increasing protein (BPI) sheep-derived polyclonal antibodies Robert C. McIntyre, Crit Care Med 2000 vol 28 No 9 ARDS -- conclusion From the experience of ‘Thirty Years of Clinical Trial in ARDS’ Lung protective ventilator strategy is the first therapy found to improve outcome in ARDS * * * * * Titration of PEEP: total PEEP with the greatest improvement in oxygenation allowing FaO2/FiO2 above 200 mmHg without worsening hemodynamics. * * * ARDS -- prone position Lim CM, Kim EK, Lee JS, et al. Comparison of the response to the prone position between pulmonary and extrapulmonary acute respiratory distress syndrome. Intensive Care Med 2001; 27: 477-85 * * ARDSnet Study Summaries Ongoing studies Late Steroid Rescue Study ALVEOLI Study Higher EELV/Lower FiO2 vs Lower EELV/Higher FiO2 Ventilation PAC Study PAC vs CVC Fluid Conservative vs. Fluid Liberal ARDS --