Document Detail


Is there a place for pressure-support ventilation and high positive end-expiratory pressure combined to alpha-2 agonists early in severe diffuse acute respiratory distress syndrome?
MedLine Citation:
PMID:  23561575     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Acute respiratory distress syndrome (ARDS) is associated with a high mortality linked primarily to co-morbidities (sepsis, cardiac failure, multiple organ failure, etc.). When the lung is the single failing organ, quick resolution of ARDS should skip some complications arising from a prolonged stay in the critical care unit. In severe ARDS (PaO2/FIO2=P/F<100 with positive end-expiratory pressure (PEEP) ≥ 5 cm H2O), current recommendations are to intubate the trachea of the patient and use mechanical ventilation, low tidal volume, high PEEP, prone positioning and possibly neuromuscular blockade in association with intravenous sedation. Another strategy is possible. Firstly, spontaneous ventilation (SV) coupled with pressure support (PS) ventilation and high PEEP is possible from tracheal intubation onwards, with the possible exception of the short period following immediately tracheal intubation. Secondly, using alpha-2 adrenergic agonists (e.g. clonidine, dexmedetomidine) can provide first-line sedation from the beginning of mechanical ventilation, as they preserve respiratory drive, lower oxygen consumption and pulmonary hypertension and increase diuresis. Alpha-2 agonists are to be supplemented, if appropriate, by drugs devoid of effect on respiratory drive (neuroleptics, etc.). The expected benefits would be to prevent acquired diaphragmatic weakness, accumulation of sedation, cognitive dysfunction, and presumably improved outcome. This hypothesis should be tested in a double blind randomized controlled trial.
Authors:
C Pichot; F Petitjeans; M Ghignone; L Quintin
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2013-04-03
Journal Detail:
Title:  Medical hypotheses     Volume:  80     ISSN:  1532-2777     ISO Abbreviation:  Med. Hypotheses     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-05-06     Completed Date:  2013-12-02     Revised Date:  2013-12-13    
Medline Journal Info:
Nlm Unique ID:  7505668     Medline TA:  Med Hypotheses     Country:  United States    
Other Details:
Languages:  eng     Pagination:  732-7     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Elsevier Ltd. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic alpha-2 Receptor Agonists / therapeutic use*
Clonidine / therapeutic use
Combined Modality Therapy
Dexmedetomidine / therapeutic use
Humans
Models, Biological
Positive-Pressure Respiration / methods*
Respiratory Distress Syndrome, Adult / therapy*
Chemical
Reg. No./Substance:
0/Adrenergic alpha-2 Receptor Agonists; 67VB76HONO/Dexmedetomidine; MN3L5RMN02/Clonidine
Comments/Corrections
Comment In:
Med Hypotheses. 2013 Nov;81(5):967   [PMID:  24047538 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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