Long post. PART 2
FLUID MANAGEMENT : too detailed to summarize here.
" Noninvasive Ventilation and High-Flow Nasal Cannula
Because intubation and mechanical ventilation may be associated with an increased incidence of complications, such as barotrauma and nosocomial pneumonia, alternatives to mechanical ventilation such as a high-flow nasal cannula or noninvasive positive-pressure ventilation (NIPPV) may be beneficial in patients with ARDS. "
SNIPPED MORE DETAILS
"Mechanical Ventilation
The goals of mechanical ventilation in ARDS are to maintain oxygenation while avoiding oxygen toxicity and the complications of mechanical ventilation. Generally, this involves maintaining oxygen saturation in the range of 85-90%, with the aim of reducing the fraction of inspired oxygen (FiO2) to less than 65% within the first 24-48 hours. Achieving this aim almost always necessitates the use of moderate-to-high levels of positive end-expiratory pressure (PEEP)."
SNIPPED DETAILS
"Positive end-expiratory pressure and continuous positive airway pressure
ARDS is characterized by severe hypoxemia. When oxygenation cannot be maintained despite high inspired oxygen concentrations, the use of CPAP or PEEP usually promotes improved oxygenation, allowing the FiO2 to be tapered." SNIPPED DETAILS OF HOW TO CONFIGURE THE APPARATUS
"Prone positioning
Some 60-75% of patients with ARDS have significantly improved oxygenation when turned from the supine to the prone position. The improvement in oxygenation is rapid and often substantial enough to allow reductions in FIO2 or level of CPAP. The prone position is safe, with appropriate precautions to secure all tubes and lines, and does not require special equipment. The improvement in oxygenation may persist after the patient is returned to the supine position and may occur on repeat trials in patients who did not respond initially.
snip
However, a subsequent randomized controlled trial in which patients with severe ARDS were placed in the prone position early and for at least 16 hours a day showed a significant mortality benefit. [48] In this study, patients with severe ARDS (PaO2/FiO2 of < 150) were randomized to prone position after 12-24 hours of stabilization. The 28-day mortality rate was 16% in the prone group and 32.8% in the supine group. Patients were turned manually. A specialized bed was not required."
"Nutritional Support
Institution of nutritional support after 48-72 hours of mechanical ventilation usually is recommended. Enteral nutrition via a feeding tube is preferable to IV hyperalimentation unless it is contraindicated because of an acute abdomen, ileus, GI bleeding, or other conditions.
A low-carbohydrate high-fat enteral formula including anti-inflammatory and vasodilating components (eicosapentaenoic acid and linoleic acid) along with antioxidants has been demonstrated in some studies to improve outcome in ARDS. [52, 53]"
"Activity Restriction
Patients with ARDS are on bed rest. Frequent position changes should be started immediately, as should passive—and, if possible, active—range-of-motion activities of all muscle groups. Elevation of the head of the bed to a 45° angle is recommended to diminish the development of VAP.
THE MEDICATION SECTION SHOULD BE READ IN FULL BY THOSE INTERESTED, recall that you need to register:
https://emedicine.medscape.com/artic...139-medication
"Medication Summary
No drug has proved beneficial in the prevention or management of acute respiratory distress syndrome (ARDS).
Early administration of corticosteroids to septic patients does not prevent the development of ARDS.
Numerous pharmacologic therapies, including the use of inhaled or instilled synthetic surfactant, intravenous (IV) antibody to endotoxin, ketoconazole, and ibuprofen, have been tried and are not effective.
Statins, which also appeared to have promise in small studies, also did not show benefit in a recently published randomized trial in 60 patients with acute lung injury (ALI). [57]"
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BUT THE REFERENCED ABSTRACT SAYS IT DID HELP, IF I UNDERSTAND IT CORRECTLY:
NOTE 57:
https://reference.medscape.com/medli...tract/20870757
A randomized clinical trial of hydroxymethylglutaryl- coenzyme a reductase inhibition for acute lung injury (The HARP Study).
Am J Respir Crit Care Med. 2011; 183(5):620-6 (ISSN: 1535-4970)
Craig TR; Duffy MJ; Shyamsundar M; McDowell C; O'Kane CM; Elborn JS; McAuley DF
RATIONALE: There is no effective pharmacological treatment for acute lung injury (ALI). Statins are a potential new therapy because they modify many of the underlying processes important in ALI.
OBJECTIVES: To test whether simvastatin improves physiological and biological outcomes in ALI.
SNIP
CONCLUSIONS: Treatment with simvastatin appears to be safe and may be associated with an improvement in organ dysfunction in ALI. These clinical effects may be mediated by a reduction in pulmonary and systemic inflammation. Clinical trial registered with
www.controlled-trials.com (ISRCTN70127774).
What This Study Adds to the Field
We have found, in a randomized, double-blind trial of 60
patients with ALI, that simvastatin was safe and showed
modest improvements in nonpulmonary organ dysfunction,
improvement in systemic organ dysfunction, and a reduction
in IL-8 in the airspaces of the lung.
FULL STUDY URL:
https://www.researchgate.net/publica...00000/download
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