scholarly journals Pulmonary Surfactant Preparations and Surfactant Therapy for ARDS in Surgical Intensive Care (a Literature Review)

2019 ◽  
Vol 9 (1) ◽  
pp. 50-65 ◽  
Author(s):  
O. A. Rosenberg
Keyword(s):  
Clinical Trials ◽  
Intensive Care ◽  
Mortality Rate ◽  
Literature Review ◽  
Pulmonary Surfactant ◽  
Phase Iii ◽  
Surfactant Therapy ◽  
Pulmonary Surfactants ◽  
Surgical Intensive Care ◽  
Treatment And Prevention

Introduction. Despite the fact that clinical studies of pulmonary surfactants conducted over many years have demonstrated their efficacy for the treatment of acute respiratory distress syndrome (ARDS) which led to their approval for use inRussia andBelarus, only a few similar positive results have been achieved in other countries. This calls for an extensive literature review for intensive care professionals.Materials and methods. Using the data from 87 papers this review covers the composition, properties, methods of administration and delivery strategies of surfactant in the treatment and prevention of ARDS in patients with sepsis, severe complex injuries, inhalation injuries and a range of complications associated with thoracic and cardiovascular surgical procedures, massive blood transfusions, severe obstetric pathologies and the A/H1N1 pneumonia.Results. The early administration of natural pulmonary surfactants within 24 hours following the onset of ARDS as a part of the ARDS combination treatment or prevention drives down the time on mechanical ventilation to six days or shorter, prevents ventilator-associated and hospital-acquired pneumonias, bringing the respiratory failure mortality rate down to 15–20%.Discussion. Offering the first attempt to discuss the causes of failure of Phase III multicenter clinical trials outsideRussia andBelarus, this review outlines recent developments in synthetic and powdered pulmonary surfactant preparations.Conclusion. Pulmonary surfactants are highly effective as a part of complex therapy in ARDS treatment and prevention, resulting in two to four fold drop in ARDS mortality rate. The timing of administration is seen as the key factor of the efficacy of surfactant therapy, explaining the differences in clinical trials results from different countries.

scholarly journals Incidence and outcomes of acute lung injury in the surgical intensive care unit of a tertiary care hospital in Bangkok, Thailand

2017 ◽  
Vol 10 (4) ◽  
pp. 379-385
Author(s):  
Onuma Chaiwat ◽  
Worawan Suwannasri ◽  
Jedsadayoot Sak-aroonchai ◽  
Sawita Kanavitoon ◽  
Annop Piriyapathsom ◽  
...  
Keyword(s):  
Intensive Care ◽  
Acute Lung Injury ◽  
Mortality Rate ◽  
Lung Injury ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
Surgical Intensive Care Unit ◽  
Apache Ii Score ◽  
Care Hospital ◽  
Surgical Intensive Care

Abstract Background Although the pathophysiology and treatment of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are well established, the incidence and outcomes of ALI have not been extensively reported. Variations in healthcare systems, demographics, socioeconomics, and levels of intensive care units (ICU) may explain remarkable differences in outcomes reported. Objectives To evaluate the incidence and outcomes of ALI/ARDS at the surgical ICU (SICU) at Siriraj Hospital of Mahidol University, Bangkok. Methods We included patients aged ≥18 years admitted to the general SICU between June 1, 2010 and May 31, 2013 in this prospective, cohort observational study. All patients required ≥24 h of ventilatory support. The study outcomes were the incidence of ALI/ARDS, SICU length of stay, and mortality rate. Results Of 2523 patients admitted to the SICU, 495 (20%) required ≥24 h ventilatory support, and 15 (3%) developed ALI/ARDS. ALI/ARDS occurred on day 2 of ventilatory support. ARDS was caused by sepsis and pneumonia. The patients who developed ALI/ARDS had a higher APACHE II score (P = 0.001) and end-stage renal disease (P = 0.01). Pneumonia and acute kidney injury were more severe in patients with ALI and ARDS (40% vs 9%, P = 0.002; 33% vs 10%, P = 0.02, respectively). Ventilatory support duration, SICU lengths of stay and hospital mortality were higher in the ALI/ARDS group. Conclusions The incidence of ALI/ARDS in the SICU was low, but the mortality rate was high. A larger sample size is necessary to identify independent risk factors for ALI/ARDS.

scholarly journals Association of hyperchloremia with all-cause mortality in patients admitted to the surgical intensive care unit: a retrospective cohort study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Keke Song ◽  
Tingting Yang ◽  
Wei Gao
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Heart Disease ◽  
Mortality Rate ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards Model ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Admission ◽  
The Relationship

Abstract Background Serum chloride (Cl−) is one of the most essential extracellular anions. Based on emerging evidence obtained from patients with kidney or heart disease, hypochloremia has been recognized as an independent predictor of mortality. Nevertheless, excessive Cl− can also cause death in severely ill patients. This study aimed to investigate the relationship between hyperchloremia and high mortality rate in patients admitted to the surgical intensive care unit (SICU). Methods We enrolled 2131 patients from the Multiparameter Intelligent Monitoring in Intensive Care III database version 1.4 (MIMIC-III v1.4) from 2001 to 2012. Selected SICU patients were more than 18 years old and survived more than 72 h. A serum Cl− level ≥ 108 mEq/L was defined as hyperchloremia. Clinical and laboratory variables were compared between hyperchloremia (n = 664) at 72 h post-ICU admission and no hyperchloremia (n = 1467). The Locally Weighted Scatterplot Smoothing (Lowess) approach was utilized to investigate the correlation between serum Cl- and the thirty-day mortality rate. The Cox proportional-hazards model was employed to investigate whether serum chlorine at 72 h post-ICU admission was independently related to in-hospital, thirty-day and ninety-day mortality from all causes. Kaplan-Meier curve of thirty-day and ninety-day mortality and serum Cl− at 72 h post-ICU admission was further constructed. Furthermore, we performed subgroup analyses to investigate the relationship between serum Cl− at 72 h post-ICU admission and the thirty-day mortality from all causes. Results A J-shaped correlation was observed, indicating that hyperchloremia was linked to an elevated risk of thirty-day mortality from all causes. In the multivariate analyses, it was established that hyperchloremia remained a valuable predictor of in-hospital, thirty-day and ninety-day mortality from all causes; with adjusted hazard ratios (95% CIs) for hyperchloremia of 1.35 (1.02 ~ 1.77), 1.67 (1.28 ~ 2.19), and 1.39 (1.12 ~ 1.73), respectively. In subgroup analysis, we observed hyperchloremia had a significant interaction with AKI (P for interaction: 0.017), but there were no interactions with coronary heart disease, hypertension, and diabetes mellitus (P for interaction: 0.418, 0.157, 0.103, respectively). Conclusion Hyperchloremia at 72 h post-ICU admission and increasing serum Cl− were associated with elevated mortality risk from all causes in severely ill SICU patients.

scholarly journals Amantadine Can be Used as a Drug for SARS-Cov-2 Treatment?

Coronaviruses ◽  
2020 ◽  
Vol 01 ◽  
Author(s):  
Zeynep Gunes Ozunal ◽  
Sevki Sahin
Keyword(s):  
Intensive Care Unit ◽  
Clinical Trials ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Nmda Receptor ◽  
Antiviral Drug ◽  
Phase Iii ◽  
Supportive Treatment ◽  
Antagonistic Effects ◽  
Phase Iii Clinical Trials

: Coronavirus Disease 2019 (COVID-19) infection, the pandemics, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has any known effective radical pharmacotherapy, just supportive approach at present. Amantadine is a drug used in Parkinson’s disease and other parkinsonisms; and is known to increase indirectly dopamine by antagonistic effects at the N-methyl-D-aspartate (NMDA) receptor by increasing the release and blocking the reuptake of dopamine. Initially, amantadine was approved as an antiviral drug. We hypothesize that if amantadine considered both antiviral, immunological and neurostimulant effects might be useful in the supportive treatment of SARS-CoV-2 cases, especially those who developed acute respiratory failure with decreased vigilance and monitored in the intensive care unit. Further phase III clinical trials are needed.

Nail Psoriasis and Biologics

2009 ◽  
Vol 13 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Kristin Noiles ◽  
Ronald Vender
Keyword(s):  
Clinical Trials ◽  
Literature Review ◽  
Severity Index ◽  
Phase Iii ◽  
Controlled Study ◽  
Extensive Literature ◽  
Open Label ◽  
Double Blind ◽  
Nail Psoriasis ◽  
Percent Improvement

Background: Since the advent of biologic therapies for psoriasis, reports of efficacy in nail psoriasis have appeared in the literature and at international conferences with increasing frequency. Objective: This article aims to review the existing literature on the use of biologics in the treatment of nail psoriasis. Methods: An extensive literature review was conducted using OVID Medline. Studies examining the efficacy of biologics in the treatment of nail psoriasis were documented. Results: A literature review revealed few clinical trials specifically concentrating on nail psoriasis; however, nails have been assessed in larger clinical trials for cutaneous psoriasis. A large, multicenter, phase III, double-blind, placebo-controlled study of infliximab administered as a brief induction regimen at weeks 0, 2, and 6 followed by a single infusion every 8 weeks revealed statistically significant mean percent improvement in the Nail Psoriasis Severity Index (NAPSI) score over placebo at both week 10 (26.8% vs −7.7%, respectively; p < .001) and week 24 (57.2% vs −4.1%, respectively; p < .001). For other biologics, evidence has thus far been largely anecdotal, appearing as either case studies or extracted secondarily from open-label prospective trials in plaque psoriasis or psoriatic arthritis. Conclusion: Infliximab appears to be the most effective treatment for nail psoriasis to date.

Sign in / Sign up

Export Citation Format

Share Document