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IDIS Index Record 587802

Title:
RECENT DEVELOPMENTS IN THE MANAGEMENT OF ACUTE RESPIRATORY DISTRESS SYNDROME IN ADULTS

Authors:
BREAM-ROUWENHORST H; BELTZ E A; ROSS M B; MOORES K G

Source:
AM J HEALTH-SYST PHARM, vol 65, iss 1, p 29-36, yr 2008

Drugs:
CORTICOSTEROIDS 68040000; METHYLPREDNISOLONE 68040006; NITRIC OXIDE 24120055; SURFACTANT-LUNG 92000014; ALPROSTADIL 24120003; EPOPROSTENOL 20120610; ALBUTEROL 12120066; ACETYLCYSTEINE 48000007

Disease:
DISEASE, LUNG NEC 518.

Descriptors:
REVIEW ADULT 6; DRUG COMBINATION 16; ADM ADMINISTRATION 44; ADM PARENT INTRAVENOUS 66; ADM INHALATION 98; DOSAGE 43; CONTRAINDICATION 52; SIDE EF ADVERSE REACTION 46

Abstract:
Purpose. Recent developments in the management of acute respiratory distress syndrome (ARDS) in adults are reviewed.
Summary. Corticosteroids have been extensively studied in ARDS; however, they have not demonstrated clear benefit in patients with ARDS. Some trials have found increased complications and mortality related to corticosteroid use. The use of conservative fluid management has been associated with significant reductions in morbidity, highlighting the need to avoid fluid overadministration in patients with ARDS. A number of ventilatory strategies have also been studied. Studies have found that higher positive end-expiratory pressure settings do not appear to be harmful in patients with ARDS. In an effort to prevent alveolar overdistention, low tidal volume and plateau pressure ventilation is increasingly being used in patients with acute lung injury (ALI). Given the increasing evidence supporting the use of lower tidal volume ventilation, this strategy has become the new standard of care in patients with suspected ALI and ARDS. No clear benefit has been shown in the treatment of ARDS with nitric oxide and surfactant. Prostaglandins and acetylcysteine are not considered useful in the treatment of ARDS, while no conclusions can be drawn regarding the benefits of albuterol on mortality in patients with ARDS. The use of prone positioning should be discouraged in the treatment of ARDS based on its associated risks.
Conclusion. Early administration of moderate-dosage corticosteroids likely helps decrease the time of ventilator dependence and duration of intensive care unit stay. Conservative fluid management and low tidal volume ventilation are becoming increasingly widespread in the management of patients with ARDS. Nitric oxide, surfactant, prostaglandins, albuterol, acetylcysteine, and prone positioning have not been shown to be beneficial in the treatment of ARDS.


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