Ards 2008

• Mesenchymální kmenové buňky intratracheálně za 4 hod po apliaci LPS – zlepšení klinického výsledku

• Protective effects of propofol on acute lung injury induced by oleic acid in conscious rats. Crit Care Med. 2008 Apr;36(4):1214-21. CONCLUSIONS: Oleic acid resulted in sepsis-like responses including ALI, inflammatory reaction, and increased neutrophil-derived factors. It depressed the Na+-K+-ATPase activity but up-regulated inducible nitric oxide synthase. Treatment with propofol abrogated or reversed the oleic acid-induced changes.

• Leukoreduction is associated with a decreased incidence of late onset acute respiratory distress syndrome after injury. Am Surg. 2008 Feb;74(2):117-23. NLR product exposure has an association with an increased incidence of late onset posttraumatic ARDS which is independent of large volume transfusions. Leukoreduction should be routinely included in an overall treatment strategy to furthermore mitigate this complication in critically ill trauma patients.

• Nové mechanismy reparace ARDS Intensive Care Med. 2008 Apr;34(4):619-30. Epub 2008 Feb 9. Advances in mechanisms of repair and remodelling in acute lung injury.

• Inhalační steroidy u časného ARDS ? Is there evidence to support a phase II trial of inhaled corticosteroids in the treatment of incipient and persistent ARDS? Crit Care Resusc. 2007 Sep;9(3):276-85

• Steroidy a ARDS 2008 ?: Když nutno, tak:

  • co nejnižší dávka

  • ne později než 14 dní od vzniku ARDS

  • časné podání nízkých dávek redukuje dobu UPV a ICU

  • steroidy nelze doporučit jako rutinní postup u ARDS

Year Book of Intensive Care and Emergency Medicine 2008

The use of an inflammation-modulating diet in patients with acute lung injury or

acute respiratory distress syndrome: a meta-analysis of outcome data.

JPEN J Parenter Enteral Nutr. 2008 Nov-Dec;32(6):596-605.

Pontes-Arruda A, Demichele S, Seth A, Singer P.

Background: This meta-analysis of clinical trials compares an

inflammation-modulating diet enriched with eicosapentaenoic acid (EPA),

gamma-linolenic acid (GLA), and elevated antioxidants (EPA + GLA) vs a control

diet to determine the effectiveness of this specialized diet on oxygenation and

clinical outcomes in mechanically ventilated patients with acute lung injury

(ALI)/acute respiratory distress syndrome (ARDS). Methods: MEDLINE, EMBASE,

Cochrane Clinical Trials Register, and the U.S. National Institute of Health

Clinical Trials databases were searched. The outcome measures assessed were

28-day in-hospital mortality, 28-day ventilator-free and intensive care unit

(ICU)-free days, and the development of new organ failures. An evaluation of

oxygenation and ventilatory variables was also performed. Outcomes were analyzed

using both fixed-effects and random-effects models. Results: Three randomized

controlled studies (n = 411 patients) were included in this meta-analysis. Among

the most important findings of this evaluation is a significant reduction in the

risk of mortality (odds ratio [OR] = 0.40; 95% confidence interval [CI] =

0.24-0.68; P = .001), with significant reductions in the risk of developing new

organ failures (OR = 0.17; 95% CI = 0.08-0.34; P < .0001), time on mechanical

ventilation (standardized mean difference [SMD] = 0.56; 95% CI = 0.32-0.79; P <

.0001), and ICU stay (SMD = 0.51; 95% CI = 0.27-0.74; P < .0001) in patients who

received EPA + GLA. Conclusions: The meta-analysis showed a significant reduction