Ventilation in the prone position improves oxygenation but most clinical studies have not shown that prone ventilation improves outcome. In a study of paediatric patients (2 weeks to 18 years of age) with acute lung injury, prone positioning did not significantly reduce ventilator-free days or improve clinical outcome.
However, in a study published in 2006, prolonged prone positioning (at least 20 hours a day) in patients greater than 18 years of age showed that it was safe and may reduce mortality.
There was no significant difference in mortality (25.5% in the conservative group vs. 28.4% in the liberal group). However, the conservative strategy improved the oxygenation index, lung injury score, increased the number of ventilator free days and days not spent in ICU. The conservative strategy did not increase the incidence or prevalence of shock during the study. In addition, the conservative strategy did not increase the use of dialysis during the first 60 days.
In a landmark study published in 2006, the use of PA catheter guided therapy did not improve organ function or survival as compared to CVC guided therapy. The PA catheter was associated with more complications (twice as many catheter related complications, predominantly arrhythmias) than CVC guided therapy.
Evidence that use of steroids after the first week of ARDS improves prognosis significantly.
No benefit in the use of methylprednisolone after the first week of ARDS. Use of sterods after 14 days of ARDS was associated with increased mortality at 60 days. This was in spite of the steroid therapy and improving ventilator free shock free days during the first 28 days. Methyprednisolone did not increase infectious complications but was associated with a higher rate of neuromuscular weakness.
The beta agonist lung injury trial (BALTI) has shown that treatment with
intravenous albutamol (15ug / kg / hr) reduces extravascular lung water (EVLW)
in patients with ALI / ARDS with a reduction in plateau pressures at Day 7.
The effect on EVLW started at 48 hours. Patients receiving intravenous
salbutamol had a higher incidence ofsupraventricular arrhythmias these were not
sustained as the dose of salbutamol was modified in these patients. There was
no improvement in mortality with the use of salbutamol – however the study was
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