This feature examines the impact of pharmacologic interventions on the treatment of the critically ill patient — an area of health care that has become increasingly complex. Recent advances in drug therapy (including evolving and controversial data) for adult intensive-care-unit patients will be reviewed and assessed in terms of clinical, humanistic, and economic outcomes.
MeduriG.U., ChrousosG.P.Effectiveness of prolonged glucocorticoid treatment in acute respiratory distress syndrome: the right drug, the right way?Crit Care Med.2006; 34: 236–238.
6.
BellinganG.J.The pulmonary physician in critical care. 6: the pathogenesis of ALI/ARDS. Thorax.2002; 57: 540–546.
7.
WeinackerA.B., VaszarL.T.Acute respiratory distress syndrome: physiology and new management strategies. Annu Rev Med.2001; 52: 221–237.
8.
MarshallR., BellinganG., LaurentG.The acute respiratory distress syndrome: fibrosis in the fast lane. Thorax.1998; 53: 815–817.
9.
BaudouinS.V.Manipulation of inflammation in ARDS: achievable goal or distant target?Thorax.2006; 61: 464–465.
10.
VincentJ.L., BihariD.J., SuterP.M.. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA.1995; 274: 639–644.
11.
VincentJ.L., ZambonM.Why do patients who have acute lung injury/acute respiratory distress syndrome die from multiple organ dysfunction syndrome? Implications for management. Clin Chest Med.2006; 27: 725–731; abstract x-xi.
12.
MarshallR.P., BellinganG., WebbS.. Fibroproliferation occurs early in the acute respiratory distress syndrome and impacts on outcome. Am J Respir Crit Care Med.2000; 162: 1783–1788.
13.
ChesnuttA.N., MatthayM.A., TibayanF.A., ClarkJ.G.Early detection of type III procollagen peptide in acute lung injury. Pathogenetic and prognostic significance. Am J Respir Crit Care Med.1997; 156: 840–845.
14.
LieblerJ.M., QuZ., BucknerB., PowerM.B., RosenbaumJ.T.Fibroproliferation and mast cells in the acute respiratory distress syndrome. Thorax.1998; 53: 823–829.
15.
BellinganG.J., MarshallR.P., LaurentG.J.Fibrosis in ARDS: How close is the link between inflammation and fibroproliferation? In: VincentJ.L., ed. Yearbook of Intensive Care and Emergency Medicine.Berlin, Germany: Springer; 2000; 217–224.
SchwartzM.D., MooreE.E., MooreF.A.. Nuclear factor-kappa B is activated in alveolar macrophages from patients with acute respiratory distress syndrome. Crit Care Med.1996; 24: 1285–1292.
18.
MeduriG.U., MuthiahM.P., CarratuP., EltorkyM., ChrousosG.P.Nuclear factor-kappaB- and glucocorticoid receptor alpha- mediated mechanisms in the regulation of systemic and pulmonary inflammation during sepsis and acute respiratory distress syndrome. Evidence for inflammation-induced target tissue resistance to glucocorticoids. Neuroimmunomodulation.2005; 12: 321–338.
19.
MeduriG.U., HeadleyA.S., GoldenE.. Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial. JAMA.1998; 280: 159–165.
20.
BernardG.R., ArtigasA., BrighamK.L.. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med.1994; 149: 818–824.
21.
AtabaiK., MatthayM.A.The pulmonary physician in critical care. 5: acute lung injury and the acute respiratory distress syndrome: definitions and epidemiology. Thorax.2002; 57: 452–458.
22.
WheelerA.P., BernardG.R., SchoenfeldD., SteinbergK.Methylprednisolone for unresolving ARDS. JAMA.1998; 280: 2074.
23.
MacLarenR., JungR.Stress-dose corticosteroid therapy for sepsis and acute lung injury or acute respiratory distress syndrome in critically ill adults. Pharmacotherapy.2002; 22: 1140–1156.
24.
HooperR.G., KearlR.A.Established ARDS treated with a sustained course of adrenocorticol steroids. Chest.1990; 97: 138–143.
25.
MeduriG.U., BelenchiaJ.M., EstesR.J., WunderinkR.G., el TorkeyM., LeeperK.V.Fibroproliferative phase of ARDS: clinical findings and effects of corticosteroids. Chest.1991; 100: 943–952.
26.
SteinbergK.P., HudsonL.D., GoodmanR.B.. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med.2006; 354: 1671–1684.
27.
HuangC.J., LinH.C.Association between adrenal insufficiency and ventilator weaning. Am J Respir Crit Care Med.2006; 173: 276–280.
28.
KehD., SprungC.L.Use of corticosteroid therapy in patients with sepsis and septic shock: an evidence-based review. Crit Care Med.2004; 32: S527–S533.
29.
StreckW.F., LockwoodD.H.Pituitary adrenal recovery following short-term suppression with corticosteroids. Am J Med.1979; 66: 910–914.
30.
HenzenC., SuterA., LerchE., UrbinelliR., SchomoX.H., BrinerV.A.Suppression and recovery of adrenal response after short-term, high-dose glucocorticoid treatment. Lancet.2000; 355: 542–545.
31.
MeduriG.U., TolleyE.A., ChrousosG.P., StentzF.Prolonged methylprednisolone treatment suppresses systemic inflammation in patients with unresolving acute respiratory distress syndrome: evidence for inadequate endogenous glucocorticoid secretion and inflammation-induced immune cell resistance to glucocorticoids. Am J Respir Crit Care Med.2002; 165: 983–991.
32.
KehD., BoehnkeT., Weber-CartensS.. Immunologic and hemodynamic effects of “low-dose” hydrocortisone in septic shock: a double-blind, randomized, placebo-controlled, crossover study. Am J Respir Crit Care Med.2003; 167: 512–520.
33.
Van den BergheG., WoutersP.J., BouillonR.. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control. Crit Care Med.2003; 3: 359–366.
34.
De JongheB., SharsharT., LefaucheurJ.P.. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA.2002; 288: 2859–2867.
35.
HermansG., WilmerA., MeerssemanW.. Impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit. Am J Respir Crit Care Med.2007; 175: 480–489.
36.
SprungC.L., CaralisP.V., MarcialE.H.. The effect of high dose corticosteroids in patients with septic shock. N Engl J Med.1984; 311: 1137–1143.
BernardG.B., LuceJ.M., SprungC.L.. High dose corticosteroids in patients with the adult respiratory distress syndrome. N Engl J Med.1987; 317: 1565–1570.
39.
LuceJ.M., MontgomeryA.B., MarksJ.D., TurnerJ., MetzC.A., MurrayJ.F.Ineffectiveness of high-dose methylprednisolone in preventing parenchymal lung injury and improving mortality in patients with septic shock. Am Rev Respir Dis.1988; 138: 62–68.
40.
AnnaneD., SebilleV., BellissantE., Ger-Inf-05 Study Group. Effect of low doses of corticosteroids in septic shock patients with or without early acute respiratory distress syndrome. Crit Care Med.2006; 34: 22–30.
41.
AnnaneD., SebilleV., CharpentierC.. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA.2002; 288: 862–871.
42.
DellingerR.P.Post hoc analyses in sepsis trials: a formula for disappointment?Crit Care Med.1996; 24: 727–729.
43.
AssmannS.F., PocockS.J., EnosL.E., KastenL.E.Subgroup analysis and other (mis)uses of baseline data in clinical trials. Lancet.2000; 355: 1064–1069.
44.
MeduriG.U., GoldenE., FreireA.X.. Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest.2007; 131: 954–963.
45.
Vieillard-BaronA., GirouE., ValenteE.. Predictors of mortality in acute respiratory distress syndrome. Focus on the role of right heart catheterization. Am J Respir Crit Care Med.2000; 161: 1597–1601.
46.
HerridgeM.S., CheungA.M., TanseyC.M.. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med.2003; 348: 683–693.
47.
The Acute Respiratory Distress Syndrome Network.Ventilation with lower tidal volumes as compared to traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Eng J Med.2000; 342: 1301–1308.
48.
AngusD.C., AbrahamE.Intensive insulin therapy in critical illness. Am J Respir Crit Care Med.2005; 172: 1358–1359.
