Method for treating early severe diffuse acute respiratory distress syndrome
View Patent ↗A method for treatment of severe diffuse acute respiratory distress syndrome in an intubated-ventilated patient which includes sedating said patient with at least one alpha-2 agonist, maintaining spontaneous ventilation and applying pressure support ventilation of at least 5-10 cmH 2 O combined to a high positive end expiratory pressure (PEEP) of 10-24 cmH 2 O. A pharmaceutical composition containing at least one alpha-2 agonist suitable for treatment of ARDS in combination with, if appropriate, at least one sedative agent which does not depress ventilatory drive is also disclosed.
1. A method for treating early severe diffuse acute respiratory distress syndrome (ARDS) in an intubated-ventilated patient, said method comprising the following steps:
a) sedating said patient with a sedating agent S comprising at least one alpha-2 agonist to Ramsay sedation scale: 3<Ramsay<4,
b) applying positive end expiratory pressure PEEP of 10-24 cm H2O;
c) maintaining spontaneous ventilation and applying pressure support ventilation: 5-10 cm H 2 O or up to a transpulmonary pressure<25 cm H2O, with a plateau pressure (Pplat)<26-32 mm Hg).
2. The method of claim 1 , wherein said alpha-2 agonist comprises clonidine or dexmedetomidine.
3. The method of claim 1 , further comprising, administering a sedative agent S′ which differs from the sedating agent S and which does not depress ventilatory drive.
4. The method of claim 3 , wherein said sedative agent S′ is selected from the group consisting of neuroleptics, hydroxyzine, ketamine, gamma-hydroxybutyric acid and combinations thereof.
5. The method of claim 1 , wherein sedation and spontaneous ventilation-pressure support-intubation of steps a) and c) are maintained until the PaO 2 /FiO 2 (P/F) ratio >200 for >12 h to 24 h.
6. The method of claim 1 , comprises a step d) wherein the trachea of the patient is extubated and a step e) wherein sedation (2<Ramsay<3) and spontaneous ventilation-non invasive ventilation, are maintained until said P/F ratio is >300 for 24 h.
7. The method of claim 1 , wherein sedation and spontaneous ventilation-pressure support of steps a) and c) are maintained with permissive hypercapnia (PaCO 2 <60 mmHg, arterial blood pH >7.2).
8. The method of claim 1 , wherein respiratory rate is controlled with mild hypothermia (34-36° C.) so as to obtain a respiratory rate (RR) compatible with spontaneous ventilation and lowered oxygen demand (RR<35-40 breaths per min for a few h; RR<20 bpm for extended periods: 2-5 days).
9. The method of claim 1 , further comprises:
f) evaluation of the right ventricular function by daily echocardiography to avoid RV dilatation or septal bulging, wherein the echocardiography should be conducted with incremental PEEP (0-30 cm H2O) to define the tolerance of the RV to high PEEP and wherein once the best compromise between PEEP and RV function is achieved, passive leg raising will define tolerance to volume loading, to reduce requirements of vasopressor or inotrope.
10. The method of claim 1 , further comprises:
g) administering at least one inotrope or vasopressor, as indicated following daily echocardiography.