Pharmacological treatments in ARDS; a state-of-the-art update

Boyle, Andrew James; Sweeney, Rob Mac; McAuley, Daniel F.

doi:10.1186/1741-7015-11-166

Cited by 126 publications

(86 citation statements)

References 40 publications

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“…7 In the present guideline, we systematically and transparently review the available evidence for fluid and drug interventions in patients fulfilling the ARDS criteria regardless of the underlying disease.…”

Section: Editorial Comment: What This Article Tells Usmentioning

confidence: 99%

Scandinavian clinical practice guideline on fluid and drug therapy in adults with acute respiratory distress syndrome

Claesson

Freundlich

Gunnarsson

et al. 2016

Acta Anaesthesiol Scand

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Background The objective of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) task force on fluid and drug therapy in adults with acute respiratory distress syndrome (ARDS) was to provide clinically relevant, evidence‐based treatment recommendations according to standards for trustworthy guidelines. Methods The guideline was developed according to standards for trustworthy guidelines, including a systematic review of the literature and use of the GRADE methodology for assessment of the quality of evidence and for moving from evidence to recommendations. Results A total of seven ARDS interventions were assessed. We suggest fluid restriction in patients with ARDS (weak recommendation, moderate quality evidence). Also, we suggest early use of neuromuscular blocking agents (NMBAs) in patients with severe ARDS (weak recommendation, moderate quality evidence). We recommend against the routine use of other drugs, including corticosteroids, beta2 agonists, statins, and inhaled nitric oxide (iNO) or prostanoids in adults with ARDS (strong recommendations: low‐ to high‐quality evidence). These recommendations do not preclude the use of any drug or combination of drugs targeting underlying or co‐existing disorders. Conclusion This guideline emphasizes the paucity of evidence of benefit – and potential for harm – of common interventions in adults with ARDS and highlights the need for prudence when considering use of non‐licensed interventions in this patient population.

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Section: Editorial Comment: What This Article Tells Usmentioning

confidence: 99%

Scandinavian clinical practice guideline on fluid and drug therapy in adults with acute respiratory distress syndrome

Claesson

Freundlich

Gunnarsson

et al. 2016

Acta Anaesthesiol Scand

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“…3,4 Because of the high mortality rate and its substantial impact on public health, novel therapeutic approaches for ARDS are badly needed. 5 Originally based in popular use by successive generations, traditional medicine has been a source of pharmacotherapy for millions of people worldwide. [6][7][8] Plants can provide a vast source of active natural products for the discovery of new drugs.…”

Section: Introductionmentioning

confidence: 99%

α-bisabolol-loaded lipid-core nanocapsules reduce lipopolysaccharide-induced pulmonary inflammation in mice

D'Almeida¹,

Oliveira²,

Souza³

et al. 2017

IJN

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Acute respiratory distress syndrome (ARDS) is a severe clinical condition of respiratory failure due to an intense inflammatory response with different etiologies. Despite all efforts, therapy remains limited, and ARDS is still associated with high mortality and morbidity. Plants can provide a vast source of active natural products for the discovery of new drugs. α-bisabolol (α-bis), a constituent of the essential oil from chamomile, has elicited pharmacological interest. However, the molecule has some limitations to its biological application. This study was conducted to develop a drug delivery system using lipid-core nanocapsules (LNCs) to improve the anti-inflammatory effects of orally administered α-bis. α-bis-loaded LNCs (α-bis-LNCs) were prepared by interfacial deposition of poly(ε-caprolactone) and orally administered in a mouse model of ARDS triggered by an intranasal administration of lipopolysaccharide (LPS). We found that α-bis-LNCs (30, 50, and 100 mg kg −1 ) significantly reduced airway hyperreactivity (AHR), neutrophil infiltration, myeloperoxidase activity, chemokine levels (KC and MIP-2), and tissue lung injury 18 hours after the LPS challenge. By contrast, free α-bis failed to modify AHR and neutrophil accumulation in the bronchoalveolar lavage effluent and lung parenchyma and inhibited elevation in the myeloperoxidase and MIP-2 levels only at the highest dose. Furthermore, only α-bis-LNCs reduced LPS-induced changes in mitogen-activated protein kinase signaling, as observed by a significant reduction in phosphorylation levels of ERK1/2, JNK, and p38 proteins. Taken together, our results clearly show that by using LNCs, α-bis was able to decrease LPS-induced inflammation. These findings may be explained by the robust increase of α-bis concentration in the lung tissue that was achieved by the LNCs. Altogether, these results indicate that α-bis-LNCs should further be investigated as a potential alternative for the treatment of ARDS.

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“…6 There is currently no effective pharmacological therapy which targets the underlying mechanisms implicated in the development of ARDS. 7 The National Heart, Lung and Blood Institute Working Group considered the future research directions in ARDS and highlighted the lung epithelium as an important target for new therapies for ARDS. 8 Keratinocyte Growth Factor (KGF) modulates several mechanisms recognised to be important in alveolar epithelial repair 9 and therefore may be a potential therapeutic Additional mechanistic outcomes are listed in the study protocol but are not reported in this paper.…”

Section: Introductionmentioning

confidence: 99%

Keratinocyte growth factor for the treatment of the acute respiratory distress syndrome (KARE): a randomised, double-blind, placebo-controlled phase 2 trial

McAuley

Cross

Hamid

et al. 2017

The Lancet Respiratory Medicine

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Pharmacological treatments in ARDS; a state-of-the-art update

Cited by 126 publications

References 40 publications

Scandinavian clinical practice guideline on fluid and drug therapy in adults with acute respiratory distress syndrome

Scandinavian clinical practice guideline on fluid and drug therapy in adults with acute respiratory distress syndrome

α-bisabolol-loaded lipid-core nanocapsules reduce lipopolysaccharide-induced pulmonary inflammation in mice

Keratinocyte growth factor for the treatment of the acute respiratory distress syndrome (KARE): a randomised, double-blind, placebo-controlled phase 2 trial

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Pharmacological treatments in ARDS; a state-of-the-art update

Cited by 126 publications

References 40 publications

Scandinavian clinical practice guideline on fluid and drug therapy in adults with acute respiratory distress syndrome

Scandinavian clinical practice guideline on fluid and drug therapy in adults with acute respiratory distress syndrome

&alpha;-bisabolol-loaded lipid-core nanocapsules reduce lipopolysaccharide-induced pulmonary inflammation in mice

Keratinocyte growth factor for the treatment of the acute respiratory distress syndrome (KARE): a randomised, double-blind, placebo-controlled phase 2 trial

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α-bisabolol-loaded lipid-core nanocapsules reduce lipopolysaccharide-induced pulmonary inflammation in mice