Usefulness of a selective neutrophil elastase inhibitor (sivelestat) in septic ARDS patients after gastrointestinal surgery.

Togo S, Matsuo K, Ishibe A, Nagano Y, Takahashi M, Mochizuki H, Osada S, Kameda K, Shimada H.

Hepatogastroenterology. 2008 May-Jun;55(84):967-73.

BACKGROUND/AIMS: The usefulness of a neutrophil elastase inhibitor (sivelestat)

was evaluated for treating septic acute respiratory distress syndrome (ARDS)

after gastrointestinal surgery. METHODOLOGY: The subjects were 36 patients with

septic ARDS after gastrointestinal surgery. ARDS was defined as acute lung injury

associated with systemic inflammatory response syndrome. Sivelestat was

intravenously administered at a dose of 0.2 mg/kg/hr continuously for 3 days or

more. The effectiveness of sivelestat was evaluated based on the lung injury

score, P/F ratio, and ventilator free days (VFD). RESULTS: Marked responses were

observed in 12 patients (33.3%), responses in 17 (47.2%), and no response in 7

(19.4%). In the patients with marked responses or responses (responders), the P/F

ratio was significantly improved on day 3 of drug administration and at the end

of administration compared with the pre-administration ratio. Comparison between

the responders and non-responders showed significant differences on day 3 and at

the end of drug administration. VFD significantly differed between the responders

(18.8 days) and the non-responders (11.0 days). CONCLUSION: In conclusion,

Sivelestat may be effective against septic ARDS. The effectiveness of the drug

Could be determined based on improvement in oxygenation ability on day 3 of drug

Administration.

ARDS 2009

Early packed red blood cell transfusion and acute respiratory distress syndrome

After trauma.

Anesthesiology. 2009 Feb;110(2):351-60.

Early transfusion of PRBCs is an independent predictor of ARDS in adult trauma

Patients. Conservative transfusion strategies that decrease PRBC exposure by even

Unit may be warranted to reduce the risk of ARDS in injured patients.

Mechanical ventilation guided by esophageal pressure in acute lung injury.

N Engl J Med. 2008 Nov 13;359(20):2095-104. Epub 2008 Nov 11.

As compared with the current standard of care, a

Ventilator strategy using esophageal pressures to estimate the transpulmonary

Pressure significantly improves oxygenation and compliance. Multicenter clinical

Trials are needed to determine whether this approach should be widely adopted.

A Search for subgroups of patients with ARDS who may benefit from surfactant

replacement therapy: a pooled analysis of five studies with recombinant

Surfactant protein-C surfactant (Venticute).

Chest. 2008 Oct;134(4):724-32. Epub 2008 Aug 8.

RSP-C surfactant improved oxygenation in patients with ARDS irrespective of the

Predisposition. Post hoc evidence of reduced mortality associated with surfactant

Treatment was obtained in patients with severe respiratory insufficiency due to

Pneumonia or aspiration. Those patients are the focus of a current randomized,

Blinded, clinical trial with rSP-C surfactant.

Preemptive antibiotic treatment based on gram staining reduced the incidence of

ARDS in mechanically ventilated patients.

J Trauma. 2008 Aug;65(2):309-15; discussion 315.

Date: 2016-01-05; view: 1339