Ards 2007

Anaesthesia. 2007 Aug;62(8):835-7.

• Acute lung injury probably associated with infusion of propofol emulsion.

Chondrogiannis KD, Siontis GC, Koulouras VP, Lekka ME, Nakos G.

Intensive Care Unit, University Hospital of Ioannina, Greece.

We present a case of acute lung injury associated with propofol infusion in a

mechanically ventilated patient with intracerebral haemorrhage. Diagnosis was

based on the exclusion of other risk factors inducing acute lung injury and on

the clinical improvement after discontinuation of the propofol emulsion.

Laboratory data such as the increase in total phospholipids, neutral lipids and

free fatty acids in the broncho-alveolar lavage fluid, the remarkably high

percentage of alveolar macrophages including fat droplets and the similar lipid

composition of propofol and broncho-alveolar lavage fluid support the

relationship between propofol and acute lung injury.

Cochrane Database Syst Rev. 2007 Jul 18;(3):CD003844.

• Lung protective ventilation strategy for the acute respiratory distress syndrome.

Petrucci N, Iacovelli W.

MAIN RESULTS: We found one new study in

this update for a total of six trials, involving 1297 patients, which were

eligible for inclusion. Mortality at day 28 was significantly reduced by

lung-protective ventilation: relative risk (RR) 0.74 (95% confidence interval

(CI) 0.61 to 0.88); hospital mortality was reduced: RR 0.80 (95% CI 0.69 to

0.92); Overall mortality was not significantly different if a plateau pressure

less than or equal to 31 cm H2O in control group was used: RR 1.13 (95% CI 0.88

to 1.45). There was insufficient evidence about morbidity and long term outcomes.

AUTHORS' CONCLUSIONS: Clinical heterogeneity, such as different lengths of follow

up and higher plateau pressure in control arms in two trials, make the

interpretation of the combined results difficult. Mortality is significantly

reduced at day 28 and at the end of hospital stay. The effects on long-term

mortality are unknown, although the possibility of a clinically relevant benefit

cannot be excluded.

Crit Care Resusc. 2007 Sep;9(3):276-85.

• Is there evidence to support a phase II trial of inhaled corticosteroids in the treatment of incipient and persistent ards?

Reade MC, Milbrandt EB.

There is currently sufficient evidence to support a preliminary clinical trial of inhaled

corticosteroids in patients at high risk of ARDS as well as with early and/or

late ARDS, using markers of inflammation as a surrogate end-point.

Chest. 2007 Oct 9; [Epub ahead of print]

• PRONE POSITIONING UNLOADS THE RIGHT VENTRICLE IN SEVERE ACUTE RESPIRATORY DISTRESS SYNDROME.

Conclusion In the most severe forms of ARDS, prone positioning was an efficient means of controlling right ventricular pressure overload.

Thorax. 2007 Oct 19; [Epub ahead of print]

• In vivo and In vitro effects of Salbutamol upon alveolar epithelial repair in acute lung injury.

Perkins GD, Gao F, Thickett DR.

Intravenous salbutamol reduced measures of alveolar-capillary permeability in patients with ARDS. In vitro, salbutamol stimulated both wound repair, spreading and proliferation of A549 cells and distal lung epithelial cells. Lung lavage fluid from patients treated with

salbutamol enhanced wound repair responses compared to placebo treated patients

in vitro by an IL1-â dependent mechanism. CONCLUSIONS: Our in-vivo and in-vitro

work suggests that salbutamol may stimulate epithelial repair - potentially a

pharmacological first in ARDS.