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Intensive Care Medicine

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01.05.2016 | What's New in Intensive Care

Adjuvants to mechanical ventilation for acute respiratory distress syndrome

verfasst von: Laveena Munshi, Gordon Rubenfeld, Hannah Wunsch

Erschienen in: Intensive Care Medicine | Ausgabe 5/2016

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Excerpt

An adjuvant for the acute respiratory distress syndrome (ARDS) is any intervention, in addition to or instead of mechanical ventilation, that is used to facilitate gas exchange or enhance compliance with lung protective ventilation (Table 1). Pharmacologic adjuvants have been the focus of many studies for years and include diuretics, corticosteroids, neuromuscular blocking agents, and inhaled pulmonary vasodilators. Non-pharmacologic agents include prone positioning, high frequency oscillatory ventilation, and extracorporeal life support. These non-pharmacologic options have been the focus of many large trials in recent years. This paper discusses the relative efficacy of these adjuvants and reviews their current use.

Table 1

Reported use of common adjuvants in ARDS

Adjuvant	Reported use in ARDS
Pharmacologic
Diuretics	39 % of patients with ARDS (single-center retrospective study) [4] Survey of intensivists: 70 % reported use [3]
Corticosteroids	70 % of UK physicians surveyed used corticosteroids in ARDS: Of these, 30 % reported initiating early in ARDS (≤7 days), 53 % reported initiating late in ARDS (>7 days) [9] LUNG SAFE^a: 17.3 % reported use across all ARDS, 23.3 % severe ARDS [10]
Continuous neuromuscular blocking agents	(Pre-Papazian trial): 15–23 % use in ARDS [9, 13] (Post-Papazian trial): LUNG SAFE: 37.8 % severe ARDS [10]
Inhaled nitric oxide	29–44 % [8, 9, 15] LUNG SAFE: 7.7 % reported use^b across all ARDS, 13.0 % severe ARDS [10]
Non-pharmacologic
Prone positioning	(Post-Guerin trial) LUNG SAFE: 7.9 % across all ARDS, 16.3 % severe ARDS [10]
High frequency oscillatory ventilation	(Pre-Ferguson/Young trials): 7–50 % (rescue therapy) [19, 20] (Post-Ferguson/Young trials): LUNG SAFE: 1.5 % severe ARDS [10]
Extracorporeal membrane oxygenation	12-fold increase in rate of use over the past decade (2004–2014) [23] LUNG SAFE: 3.2 % across all ARDS, 6.6 % severe ARDS [10]

ARDS acute respiratory distress syndrome

^aHigh corticosteroids dose defined as equivalent to 1 mg/kg methylprednisone

^bAll inhaled vasodilators

…

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Titel: Adjuvants to mechanical ventilation for acute respiratory distress syndrome
verfasst von: Laveena Munshi
Gordon Rubenfeld
Hannah Wunsch
Publikationsdatum: 01.05.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 5/2016
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-016-4327-2

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