Sound physiological basis for using inhaled pulmonary vasodilators: Can selectively vasodilate vessels well-ventilated lung units Leads to improved V/Q matching throughout the lungs Reduced PVR and PAP, leading to improved right heart...
Much of the current evidence regarding the use of steroids is conflicting Has not been shown conclusively to reduce mortality though may be of benefit in the late stages Early ARDS RCTBernard et al NEJM (1987)View Paper RCTMeduri et al Chest (2005)View Paper RCT:...
Considered to have sound physiological basis as many of the pathological processes contributing to ARDS Steroids exert an anti-inflammatory effect by inhibiting the arachidonic acid pathway and reducing eosinophil activity Proposed that this effect reduces cytokine...
RCT: ACURASYSPapazian et al NEJM (2010)View Paper RCT: ROSEARDSNet NEJM (2019)View Paper Intervention Cisatracurium vs. placebo for 48 hours Cisatracurium vs. placebo for 48 hours Population 348 patients with severe ARDS (P/F ratio <13 kPa) 1006 patients with...
Mechanisms remain unclear but thought to be due to: Reduced patient-ventilator dyssynchrony Improved chest wall compliance resulting in reduced driving pressures Anti-inflammatory effect Not established whether these are limited to (cis-) atracurium or wider NMB...
