EXPERTS’ OPINION   Free

Minerva Anestesiologica 2018 September;84(9):1093-1101

DOI: 10.23736/S0375-9393.18.12328-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Non-ventilatory therapies for acute respiratory distress syndrome

Jérémy BOURENNE ¹, Sami HRAIECH ^{2, 3} ✉, Romain RAMBAUD ^{2, 3}, Jean-Marie FOREL ^{2, 3}, Nicolas PERSICO ⁴, Christophe GUERVILLY ^{2, 3}, Laurent PAPAZIAN ^{2, 3}

¹ Medical and Emergency Resuscitation, la Timone 2 University Hospital, Aix-Marseille University, Marseille, France; ² Medical Intensive Care Unit, North Hospital, APHM, Marseille, France; ³ EA3279, Center for Studies and Research on Health Services and Quality of Life (CEReSS), Aix-Marseille University, Marseille, France; ⁴ Emergency Department, North Hospital, APHM, Aix-Marseille University, Marseille, France

Acute respiratory distress syndrome (ARDS) commonly affects intensive care unit patients and is associated with high mortality. In addition to etiologic treatment and protective ventilation, non-ventilatory therapies represent a significant part of ARDS care. Pharmacological treatments, extra corporeal devices and prone positioning are commonly grouped under this term. Studies have evaluated the individual effects of some of these non-ventilatory therapies in large randomized controlled trials. Recent advances concerning the beneficial use of neuromuscular blocking agents and prone positioning deserve attention. Conversely, the use of inhaled nitric oxide and almitrine remains to be specified. The debate concerning the role of corticosteroids could be renewed considering the emergence of new biomarkers. Finally, the use of extracorporeal membrane oxygenation and extra-corporeal CO2 removal remain under question. The aim of this review is to summarize the latest data concerning the mainly used non-ventilatory therapies and to integrate them into a global strategy of ARDS patient care.

KEY WORDS: Adult respiratory distress syndrome - Neuromuscular blocking agents - Almitrine - Nitric oxide - Respiratory therapy