الفهرس 
Clinical Definition of ARDSOnly 14 pages are availabe for public view
 |  | from | 102 |  |  |
| | | from | 102 | | |
Abstract
Several aetiological factors associated with the development of
ARDS are identified with sepsis, pneumonia, and trauma with
multiple transfusions accounting for most cases. ARDS remains a
significant health burden with substantial morbidity and mortality.
Improvements in outcome following ARDS over the past decade
are in part due to improved strategies of mechanical ventilation
and advanced support of other failing organs. Optimal treatment
involves judicious fluid management, protective lung ventilation
with low tidal volumes and moderate positive end expiratory
pressure, multi-organ support, and treatment where possible of the
underlying cause. Moreover, advances in general supportive
measures such as appropriate antimicrobial therapy, early enteral
nutrition, prophylaxis against venous thromboembolism and
gastrointestinal ulceration are likely contributory reasons for the
improved outcomes.
Developing optimal pharmacotherapy for the severe clinical
syndromes of ALI/ARDS ultimately depends on a detailed
understanding of the pathophysiology of acute pulmonary injury,
coupled with discovery-based medicinal chemical research and
focused drug activity testing in cells, animals, and patients.
Although current pharmacotherapy has not been highly successful
in increasing survival in ALI/ARDS particularly in adults, several
clinical studies shows that some agents may have a rule in
management of ARDS.
Treatment with the neuromuscular blocking agent cisatracurium
for 48 hours early in the course of severe ARDS improved the
adjusted 90-day survival rate, increased the numbers of ventilatorSummary
73
free days and days outside the ICU, and decreased the incidence
of barotrauma during the first 90 days. while iNO results in a
transient improvement in oxygenation but does not reduce
mortality and may be harmful.
Corticosteroids remain a major area of controversy in the
management of both early and late ARDS. On other hand patients
with ARDS are in a deficient oxidant-anti-oxidant balance that
can get a significant benefit if supplemented with NAC.
Statins are a potential new therapy because they modify many of
the underlying processes important in ALI.
Isoflurane preconditioning can attenuate pulmonary
proinflammatory cytokine release and decrease the mortality
induced by severe sepsis.
In addition to single-agent treatments for ALI/ARDS, the possible
benefits of combination therapies that simultaneously attack
multiple aspects of pathophysiology are also becoming more
widely appreciated. Individual pharmacological agents address
only limited aspects of the complex, multifaceted
pathophysiology of lung injury.
Cell-based gene therapy for ALI/ARDS has opened up a new
chapter in therapeutic strategy and provides a basis for the
development of an innovative approach for the prevention and
treatment of ALI/ARDS.