Pharmacological support

Attempts to modify the inflammatory process in ARDS with pharmacological agents have met with only limited success. Agents used have included non-steroidal anti-inflammatory drugs (e.g. ibuprofen), prostaglandins (alprostadil), thromboxane synthetase inhibitors (ketoconazole), antioxidants ( ^-acetylcysteine), and neutrophil activator inhibitors (e.g. pentoxifylline). Corticosteroids are beneficial in animal models, but clinical trials have been disappointing. High-dose steroids have a place in the treatment of patients with significant fibroproliferation or high bronchoalveolar eosinophil counts, where sepsis is excluded. Most progress has been made in the area of inhaled vasodilators used in an attempt to improve ventilation-perfusion relationships and decrease intrapulmonary shunting. This is achieved by increasing blood flow to ventilated lung units. Reducing pulmonary vascular resistance may also decrease pulmonary edema formation and therefore increase arterial oxygenation. Nitric oxide (NO) inhaled at concentrations from 4 to 40 ppm is a selective pulmonary vasodilator; its short half-life obviates effects on the systemic circulation. Although the results in individual patients are variable, delivery can be titrated against the response of the pulmonary circulation and PaO2. Rapid withdrawal of NO can result in severe rebound pulmonary hypertension and even cardiac arrest. NO is scavenged by red cell hemoglobin, which inactivates it, but methemoglobinemia is not a significant problem at the doses employed. Nebulized prostacyclin has similar vasodilating actions, but unlike NO may produce systemic effects. Surfactant replacement therapy does not have the same dramatic effects in adults compared with neonates in respiratory distress, and exogenous surfactant has not been demonstrated to benefit adult patients.

Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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