Flores medical - multisonic - Inhalation mit Ultraschall

ARDS

ARDS

ARDS (Adult Respiratory Distress Syndrome) is an acute lung injury associated with marked paraclinical, roentgenologic and histological changes seen in the presence of normal left-atrial pressure. A great number of aetiological factors may cause ARDS in previously lung-healthy patients. Pneumonia, aspiration, poly-trauma and septic conditions, are the most common causes of ARDS. Despite improved options in intensive care treatment, ARDS still has a mortality rate of 40 to 50%. Derangements in pulmonary microcirculation associated with a rise in capillary permeability and development of an interstitial lung oedema are considered the pathogenic mechanism. More than 50 % of the patients suffering from ARDS demonstrate a relevant pulmonary hypertension which alone is a mortality factor. Supportive measures aimed at improving oxygenation (PEEP ventilation, patient positioning, low tidal volumes) are mainstays in the management of ARDS in addition to consequent treatment of the triggering event. Significant beneficial effects of iloprost treatment include pulmonary vasodilatation, capillary membrane stabilization, and improvement of pulmonary microcirculation. Apart from its anti-inflammatory effects, iloprost also enhances the stretch-induced surfactant production in type-ll alveolar epithelial cells. Inhaled vasodilatators have been shown to cause selective vasodilatation of pulmonary vessels in well-ventilated regions of the lung (pulmonary and intrapulmonary selectivity), which results in improved oxygenation and decreased pulmonary pressure.

Regarding the administration of NO for treatment of ARDS, a Systematic Cochrane Review of Randomized Studies holds that the inhaled gas causes a transient improvement in oxygenation while mortality remains uninfluenced. Case series published describe an improved oxygenation also for inhaled iloprost, and initial ventilator settings (BIPAP mode), i.e. Pmax, PEEP and inspiratory oxygen concentration, could also be reduced. The dosage regimen for iloprost was as recommended for chronic idiopathic PAH. The prophylactic administration of iloprost is considered a promising approach for this disease.