ARDS : SUPPORTIVE & PHARMACOLOGICAL TREATMENT ( DR LUIGI PISANI italy ) скачать в хорошем качестве

ARDS : SUPPORTIVE & PHARMACOLOGICAL TREATMENT ( DR LUIGI PISANI italy )

00:00:00 intro, cases ,defn 00:08:40 pathophysiology 00:11:30 prevention 00:16:16 nmba 00:23:17 steroids 00:29:40 pulm vasodilator 00:32:32 phenotypes 00:36:00 fluids 00:41:17 fluids inLIMC 00:44:45 trach 00:46:15 vap 00:51:00 discussion Acute Respiratory Distress Syndrome Phases Luigi discussed the three phases of Acute Respiratory Distress Syndrome (ARDS): the exudative phase, characterized by a pro-inflammatory storm and pulmonary response; the proliferative phase, where repair mechanisms are initiated; and the fibrotic phase, which results in scarred injury and poor prognosis. He emphasized the importance of early intervention to prevent the transition from the proliferative to the fibrotic phase. Luigi also highlighted the difficulty in preventing ARDS, as trials have shown limited success in aborting the inflammatory cascade storm. He noted that current pharmacological interventions mainly aim to dampen the pro-inflammatory response, facilitate repair mechanisms, and reduce pulmonary edema. Protective Ventilation and Neuromuscular Blockers Luigi discussed the use of neuromuscular blockers in ICU patients, noting that while they can reduce ventilator-induced lung injury and barotrauma, they require deep sedation and can lead to ICU-acquired weakness if abused. He referenced two major studies, the ACCURASYS trial in 2010 and the ROSE trial in 2019, which showed mixed results on the effectiveness of neuromuscular blockers in patients with moderate to severe acute respiratory distress syndrome (ARDS). Neuromuscular Blockers and Steroids in ICU He highlighted the importance of monitoring sedation and patient effort, and suggested that neuromuscular blockers should be used early and limited to 48 hours, with a focus on stopping their use as soon as possible. Luigi also emphasized the need for caution when using steroids, particularly in immunocompromised patients and those at risk of hyperglycemia. He presented guidelines from the American, European, and Japanese societies, and suggested that steroids should be used for more than 7 days to have an effect. Lastly, he recommended specific regimens for different types of ARDS, but noted that the optimal regimen is still unclear. Steroid Use and Tailored Treatment Luigi discussed the use of steroids and other drugs in treating patients, emphasizing the need for tailored treatment based on individual patient circumstances, including family values, preferences, and the local healthcare setting. He highlighted the importance of considering the nosocomial infection burden when using drugs like steroids, which can affect the immune system's response. Luigi also mentioned the potential use of nebulized heparin and inhaled vasodilators like nitric oxide, but noted the challenges and limitations of these treatments. He concluded by stating that the use of inhaled nitric oxide should be considered only in facilities with experience in its application. Phenotyping in RDS Patient Management Luigi discussed the concept of phenotyping in the context of Rds patients, emphasizing the importance of identifying subgroups and endotypes for personalized management. He highlighted the potential for using clinical data, imaging, and biomarkers to classify patients into subphenotypes. Luigi also touched on the importance of fluid therapy and hemodynamic management, stressing the need to consider fluid responsiveness before administering fluids. He suggested the passive leg raising maneuver as a feasible method to assess fluid responsiveness, even in limited resource settings. Luigi also mentioned ongoing research, such as the Pegasus trial, which aims to classify lung morphology using lung ultrasound for personalized mechanical ventilation strategies. Managing Luigi discussed the importance of understanding and managing assess vascular permeability, and consider tracheostomy in certain cases. Luigi also highlighted the importance of infection control, including ventilator-associated pneumonia and tracheobronchitis, and the role of nutrition management in patient care. He introduced the India Registry of Intensive Care (IRIS) as a valuable resource for data collection and research. The conversation ended with Luigi thanking the audience for their attention and inviting questions. Pneumonia Diagnosis and Treatment Challenges In the meeting, Dr. Tapesh and Dr. Bisani discussed the challenges of diagnosing pneumonia and the importance of microbiological diagnosis. Dr. Tapesh emphasized the need for a strategy to treat acute core pulmonary patients, while Dr. Bisani highlighted the importance of early morphological and microbiological diagnosis. Luigi agreed, noting the need for tailored fluid therapy and hemodynamic management in cases of acute core pulmonary. The discussion also touched on the role of Polymerase Chain Reaction (PCR) in diagnosing pneumonia, Dr. Tapesh concluded by expressing his belief in the cost-effectiveness of PCR when possible.