Evidence-based Pharmacotherapy for Treating a Patient with Acute Respiratory DistressSyndrome after Operation_Chinese Journal of Evidence-Based Medicine

Authors：

1. Department of Geriatrics, The Second People’s Hospital of Chengdu, Chengdu 610017, China;2. Department of Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China;3. Department of Respiratory Diseases, Third People’s Hospital of Chengdu, Chengdu 610031, China;4. Department of Intensive Care Unit, the Second People’s Hospital of Chengdu, Chengdu 610017, China;

Corresponding author：

Keywords：

Acute respiratory distress syndrome; Pharmacological therapy; Evidence-based treatment

DOI：

10.7507/1672-2531.20090181

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Objective 　Making an individualized pharmacological treatment plan for a patient of acute respiratory distress syndrome after operation.
Methods 　First, six clinical problems were put forward after assessing the patient’ s health state. Then we searched OVID versions of the ACP Journal Club (1991~2009), CENTRAL (1st Quarter 2009), CDSR (1st Quarter 2009), and MEDLINE (1991~2009) databases. Systematic reviews, meta-analyses, and randomized clinical trials about treatment of acute respiratory distress syndrome were included. The pharmacological treatment plan was made accordingly.
Results 　After evaluation, 13 studies were eligible. The evidence indicated that the restrictive strategy of fluid management, corrected hypoproteinaemia, diuresis, and low-dose corticosteroids given in the early phase could improve oxygenation and prognosis; inhaled nitric oxide, exogenous surfactant supplement, other pharmacological drugs were associated with limited improvement in oxygenation in patients with ARDS but confer no mortality benefit and may cause harm, so we did not recommend their routine use in ARDS patients. The individual treatment plan was made based on the evidence found. After 8 days of treatment, the patient was out the ICU. He recovered and was discharged after 1 month.
Conclusions 　The individual treatment plan, which was made based on high quality evidence and patient’s condition, improved treatment efficacy, shortened the stay in ICU, reduced mortality, and decreased adverse reactions.

Citation： WANG Binyou,DONG Birong,LIU Ya,HE Ping,LI Yun. Evidence-based Pharmacotherapy for Treating a Patient with Acute Respiratory DistressSyndrome after Operation. Chinese Journal of Evidence-Based Medicine, 2009, 09(9): 1026-1030. doi: 10.7507/1672-2531.20090181 Copy

1.	Rubenfeld GD, Caldwell E, Peabody E, et al. Incidence and outcomes of acute lung injury. N Engl J Med, 2005, 353(16): 1685-1693.
2.	Phua J, Badia JR, Adhikari NK, et al. Has Mortality from Acute Respiratory Distress Syndrome Decreased over Time?: A Systematic Review. Am J Respir Crit Care Med, 2009, 179(3): 220-227.
3.	Lu Y, Song Z, Zhou X, et al. A 12-month clinical survey of incidence and outcome of acute respiratory distress syndrome in Shanghai intensive care units. Intensive Care Med, 2004, 30(12): 2197-2003.
4.	Wiedemann HP, Wheeler AP, Bernard GR, et al. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Comparison of two fluidmanagement strategies in acute lung injury. N Engl J Med, 2006, 354(24): 2564-2575.
5.	Mangialardi RJ, Martin GS, Bernard GR, et al. Hypoproteinemia predicts acute respiratory distress syndrome development, weight gain, and death in patients with sepsis. Ibuprofen in Sepsis Study Group. Crit Care Med, 2000, 28(9): 3137-3145.
6.	Martin GS, Mangialardi RJ, Wheeler AP, et al. Albumin and furosemide therapy in hypoproteinemic patients with acute lung injury. Crit Care Med, 2002, 30(10): 2175-2182.
7.	Martin GS, Moss M, Wheeler AP, et al. A randomized, controlled trial of furosemide with or without albumin in hypoproteinemic patients with acute lung injury. Crit Care Med, 2005, 33(8): 1681-1687.
8.	Peter JV, John P, Graham PL, et al. Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS) in adults: meta-analysis. BMJ, 2008, 336(7651): 1006-1009.
9.	Steinberg KP, Hudson LD, Goodman RB, et al. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med, 2006, 354(16): 1671-1684.
10.	Meduri GU, Marik PE, Chrousos GP, et al. Steroid treatment in ARDS: a critical appraisal of the ARDS network trial and the recent literature. Intensive Care Med, 2008, 34(1): 61-69.
11.	Bernard GR, Luce JM, Sprung CL, et al. High-dose corticosteroids in patients with the adult respiratory distress syndrome. N Engl J Med, 1987, 317(25): 1565-1570.
12.	Tang BM, Craig JC, Eslick GD, et al. Use of corticosteroids in acute lung injury and acute respiratory distress syndrome: A systematic review and meta-analysis. Crit Care Med, 2009 Mar 25 [Epub ahead of print] .
13.	Meduri GU, Golden E, Freire AX, et al. Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest, 2007, 131(4): 954-963.
14.	Adhikari NK, Burns KE, Friedrich JO, et al. Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis. BMJ, 2007, 334(7597): 779-786.
15.	Davidson WJ, Dorscheid D, Spragg R, et al. Exogenous pulmonary surfactant for the treatment of adult patients with acute respiratory distress syndrome: results of a meta-analysis. Crit Care, 2006, 10(2): R41.
16.	Taut FJ, Rippin G, Schenk P, et al. A Search for subgroups of patients with ARDS who may benefit from surfactant replacement therapy: a pooled analysis of five studies with recombinant surfactant protein-C surfactant (Venticute). Chest, 2008, 134(4): 724-732.
17.	Adhikari NKJ, Burns KEA, Meade MO. Pharmacologic therapies for adults with acute lung injury and acute respiratory distress syndrome. Cochrane Database of Systematic Reviews, 2004, Issue 4.

1. Rubenfeld GD, Caldwell E, Peabody E, et al. Incidence and outcomes of acute lung injury. N Engl J Med, 2005, 353(16): 1685-1693.
2. Phua J, Badia JR, Adhikari NK, et al. Has Mortality from Acute Respiratory Distress Syndrome Decreased over Time?: A Systematic Review. Am J Respir Crit Care Med, 2009, 179(3): 220-227.
3. Lu Y, Song Z, Zhou X, et al. A 12-month clinical survey of incidence and outcome of acute respiratory distress syndrome in Shanghai intensive care units. Intensive Care Med, 2004, 30(12): 2197-2003.
4. Wiedemann HP, Wheeler AP, Bernard GR, et al. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Comparison of two fluidmanagement strategies in acute lung injury. N Engl J Med, 2006, 354(24): 2564-2575.
5. Mangialardi RJ, Martin GS, Bernard GR, et al. Hypoproteinemia predicts acute respiratory distress syndrome development, weight gain, and death in patients with sepsis. Ibuprofen in Sepsis Study Group. Crit Care Med, 2000, 28(9): 3137-3145.
6. Martin GS, Mangialardi RJ, Wheeler AP, et al. Albumin and furosemide therapy in hypoproteinemic patients with acute lung injury. Crit Care Med, 2002, 30(10): 2175-2182.
7. Martin GS, Moss M, Wheeler AP, et al. A randomized, controlled trial of furosemide with or without albumin in hypoproteinemic patients with acute lung injury. Crit Care Med, 2005, 33(8): 1681-1687.
8. Peter JV, John P, Graham PL, et al. Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS) in adults: meta-analysis. BMJ, 2008, 336(7651): 1006-1009.
9. Steinberg KP, Hudson LD, Goodman RB, et al. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med, 2006, 354(16): 1671-1684.
10. Meduri GU, Marik PE, Chrousos GP, et al. Steroid treatment in ARDS: a critical appraisal of the ARDS network trial and the recent literature. Intensive Care Med, 2008, 34(1): 61-69.
11. Bernard GR, Luce JM, Sprung CL, et al. High-dose corticosteroids in patients with the adult respiratory distress syndrome. N Engl J Med, 1987, 317(25): 1565-1570.
12. Tang BM, Craig JC, Eslick GD, et al. Use of corticosteroids in acute lung injury and acute respiratory distress syndrome: A systematic review and meta-analysis. Crit Care Med, 2009 Mar 25 [Epub ahead of print] .
13. Meduri GU, Golden E, Freire AX, et al. Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest, 2007, 131(4): 954-963.
14. Adhikari NK, Burns KE, Friedrich JO, et al. Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis. BMJ, 2007, 334(7597): 779-786.
15. Davidson WJ, Dorscheid D, Spragg R, et al. Exogenous pulmonary surfactant for the treatment of adult patients with acute respiratory distress syndrome: results of a meta-analysis. Crit Care, 2006, 10(2): R41.
16. Taut FJ, Rippin G, Schenk P, et al. A Search for subgroups of patients with ARDS who may benefit from surfactant replacement therapy: a pooled analysis of five studies with recombinant surfactant protein-C surfactant (Venticute). Chest, 2008, 134(4): 724-732.
17. Adhikari NKJ, Burns KEA, Meade MO. Pharmacologic therapies for adults with acute lung injury and acute respiratory distress syndrome. Cochrane Database of Systematic Reviews, 2004, Issue 4.

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