High or low doses of almitrine bismesylate in ARDS patients responding to inhaled NO and receiving norepinephrine?

Roch, Antoine; Papazian, Laurent; Brégeon, Fabienne; Gainnier, Marc; Michelet, Pierre; Thirion, Xavier; Saux, P.; Thomas, Philippe; Jammes, Yves; Auffray, J.-P.

doi:10.1007/s00134-001-1128-y

Cited by 25 publications

(17 citation statements)

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“…Candidates for VV-ECMO are typically severely hypoxemic and/or hypercapnic and unresponsive to optimal medical management, including protective ventilation with low-tidal volumes (11) and plateau pressure less than 28-30 cmH 2 O (12), high levels of PEEP (13), prone positioning (14), neuromuscular blockers (15) and/or other adjunctive therapies, including nitrous oxide (16) or almitrine (17). The recent literature suggests that a PaO 2 / FIO 2 ratio of 70-80 mmHg, Murray score >3, and pH <7.2 provide a reasonable threshold for considering VV-ECMO in adults with ARDS (18,19).…”

Section: Patient Assessment Prior To Cannulationmentioning

confidence: 99%

Veno-venous extracorporeal membrane oxygenation: cannulation techniques

et al. 2016

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The development of extracorporeal membrane oxygenation (ECMO) technology allows a new approach for the intensive care management of acute cardiac and/or respiratory failure in adult patients who are not responsive to conventional treatment. Current ECMO therapies provide a variety of options for the multidisciplinary teams who are involved in the management of these critically ill patients. In this regard, veno-venous ECMO (VV-ECMO) can provide quite complete respiratory support, even if this highly complex technique presents substantial risks, such as bleeding, thromboembolic events and infection.While VV-ECMO circuits usually include the cannulation of two vessels (double cannulation) in its classic configuration, the use of a single cannula is now possible for VV-ECMO support. Recently, experienced centers have employed more advanced approaches by cannulating three vessels (triple cannulation) which follows veno-arterio-venous (VAV) or veno-arterio-pulmonary-arterial cannulation (VAPa). However, 'triple' cannulation expands the field of application but increases the complexity of ECMO systems. In the present review, the authors focus on the indications for VV-ECMO, patient assessment prior to cannulation, the role of ultrasound-guided vessel puncture, double lumen single bicaval cannulations, and finally triple cannulation in VV-ECMO.

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Section: Patient Assessment Prior To Cannulationmentioning

confidence: 99%

Veno-venous extracorporeal membrane oxygenation: cannulation techniques

et al. 2016

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“…Phenylephrine [67] and almitrine [68] have been used in small studies, mainly as adjuncts during administration of NO. B-blockers have also been shown to increase arterial oxygenation in patients with ARDS [69].…”

Section: Treatmentmentioning

confidence: 99%

Acute Respiratory Distress Syndrome: Pathophysiology and Therapeutic Options

et al. 2012

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Acute Respiratory Distress Syndrome (ARDS) is a common entity in critical care. ARDS is associated with many diagnoses, including trauma and sepsis, can lead to multiple organ failure and has high mortality. The present article is a narrative review of the literature on ARDS, including ARDS pathophysiology and therapeutic options currently being evaluated or in use in clinical practice. The literature review covers relevant publications until January 2011. Recent developments in the therapeutic approach to ARDS include refinements of mechanical ventilatory support with emphasis on protective lung ventilation using low tidal volumes, increased PEEP with use of recruitment maneuvers to promote reopening of collapsed lung alveoli, prone position as rescue therapy for severe hypoxemia, and high frequency ventilation. Supportive measures in the management of ARDS include attention to fluid balance, restrictive transfusion strategies, and minimization of sedatives and neuromuscular blocking agents. Inhaled bronchodilators such as inhaled nitric oxide and prostaglandins confer short term improvement without proven effect on survival, but are currently used in many centers. Use of corticosteroids is also important, and appropriate timely use may reduce mortality. Finally, extra corporeal oxygenation methods are very useful as rescue therapy in patients with intractable hypoxemia, even though a survival benefit has not, to this date been demonstrated. Despite intense ongoing research on the pathophysiology and treatment of ARDS, mortality remains high. Many pharmacologic and supportive strategies have shown promising results, but data from large randomized clinical trials are needed to fully evaluate the true effectiveness of these therapies.KeywordsARDS; Pathophysiology; Treatment

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“…INO has additive effects on oxygenation with prone positioning [21] and with high frequency oscillatory ventilation [22]. The effect of iNO is not influenced by the administration of vasopressive agents, such as norepinephrine [23,24], but iNO has additive effects on oxygenation with almitrine, a selective pulmonary vasoconstrictor [25,26]. A progressive iNO weaning on several hours is suggested due to the risk of oxygenation worsening, pulmonary artery pressure increase, and hemodynamic collapse in case of sudden discontinuation [14].…”

Section: Reviewmentioning

confidence: 99%

“…The effectiveness of almitrine on oxygenation often is reduced in septic patients receiving norepinephrine [23,24]. Therefore, the use of higher doses of almitrine (16 μg/kg/min) may produce further improvement in oxygenation in patients receiving norepinephrine if they are responders to iNO [26]. The efficiency of prolonged administration of almitrine has not been evaluated.…”

Section: Reviewmentioning

confidence: 99%

Pharmacological interventions in acute respiratory distress syndrome

et al. 2013

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Pharmacological interventions are commonly considered in acute respiratory distress syndrome (ARDS) patients. Inhaled nitric oxide (iNO) and neuromuscular blockers (NMBs) are used in patients with severe hypoxemia. No outcome benefit has been observed with the systematic use of iNO. However, a sometimes important improvement in oxygenation can occur shortly after starting administration. Therefore, its ease of use and its good tolerance justify iNO optionally combined with almitirne as a rescue therapy on a trial basis. Recent data from the literature support the use of a 48-h infusion of NMBs in patients with a PaO2 to FiO2 ratio <120 mmHg. No strong evidence exists on the increase of ICU-acquired paresis after a short course of NMBs. Fluid management with the goal to obtain zero fluid balance in ARDS patients without shock or renal failure significantly increases the number of days without mechanical ventilation. On the other hand, patients with hemodynamic failure must receive early and adapted fluid resuscitation. Liberal and conservative fluid strategies therefore are complementary and should ideally follow each other in time in the same patient whose hemodynamic state progressively stabilizes. At present, albumin treatment does not appear to be justified for limitation of pulmonary edema and respiratory morbidity. Aerosolized β2-agonists do not improve outcome in patients with ARDS and one study strongly suggests that intravenous salbutamol may worsen outcome in those patients. The early use of high doses of corticosteroids for the prevention of ARDS in septic shock patients or in patients with confirmed ARDS significantly reduced the duration of mechanical ventilation but had no effect or even increased mortality. In patients with persistent ARDS after 7 to 28 days, a randomized trial showed no reduction in mortality with moderate doses of corticosteroids but an increased PaO2 to FiO2 ratio and thoracopulmonary compliance were found, as well as shorter durations of mechanical ventilation and of ICU stay. Conflicting data exist on the interest of low doses of corticosteroids (200 mg/day of hydrocortisone) in ARDS patients. In the context of a persistent ARDS with histological proof of fibroproliferation, a corticosteroid treatment with a progressive decrease of doses can be proposed.

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High or low doses of almitrine bismesylate in ARDS patients responding to inhaled NO and receiving norepinephrine?

Cited by 25 publications

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Veno-venous extracorporeal membrane oxygenation: cannulation techniques

Veno-venous extracorporeal membrane oxygenation: cannulation techniques

Acute Respiratory Distress Syndrome: Pathophysiology and Therapeutic Options

Pharmacological interventions in acute respiratory distress syndrome

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