2005 OPEN FORUM Abstracts
ADJUNCTIVE THERAPIES AND PROTECTIVE MECHANICAL VENTILATION IN THE TREATMENT OF ARDS and VILI.
Joseph DiRocco MD, David Carney MD, Lucio Pavone MD, Kathy Snyder, Gary Nieman BA.. Upstate Medical University, Department of Surgery, Syracuse, N.Y.
Background: It is now well known that use of protective mechanical ventilation can significantly reduce mortality in patients with acute respiratory distress syndrome (ARDS). Recently, several adjunctive therapies to protective mechanical ventilation have been suggested. These therapies include proning, kinetic therapy and exogenenous surfactant.
Methods: The PubMed database was used and studies describing adjunctive therapies that might act in an additive or synergists manner with protective ventilation were reviewed. In addition, we reviewed data in our laboratory using KL4 surfactant (Pavone et al. Am J Resp Crit Care Med 2005;2:A150).
Results: The majority of the experiments demonstrated that adjunctive therapies, both positional (prone and kinetic) and pharmacologic (KL4) improve lung function measured as a PaO2/FiO2 ratio (Figure). However, no studies have been conducted that were powered sufficiently to show a statistically significant mortality improvement.
Discussion: Although protective mechanical ventilation has been shown to reduce mortality in ARDS patients, mortality is still unacceptably high at 30-45%. Adjunctive therapies are being been shown to positively impact pulmonary function in both patients (prone/kinetic) and animal (KL4) models of ARDS/VILI (Figure), suggesting that they may also reduce morbidity and mortality in ARDS patients ventilated with protective mechanical ventilation.