Therapeutic approach to acute respiratory distress syndrome in critically ill adults
Keywords:
CUIDADOS CRÍTICOS; SÍNDROME DE DIFICULTAD RESPIRATORIA; TERAPÉUTICA.; CRITICAL CARE; RESPIRATORY DISTRESS SYNDROME; THERAPEUTICS.; CUIDADOS CRÍTICOS; SÍNDROME DO DESCONFORTO RESPIRATÓRIO; TERAPÊUTICA.Abstract
Introduction: acute respiratory distress syndrome is a severe condition affecting patients in intensive care units, with high mortality rates that underscore its clinical relevance.
Objective: to analyze recent scientific evidence on the most effective therapeutic interventions in the management of acute respiratory distress syndrome in critically ill adults.
Methods: a systematic review of the scientific literature was conducted across multiple databases. The search was performed using an algorithm with keywords and Boolean operators, allowing the identification of relevant sources. The selected studies were critically analyzed considering timeliness, methodological quality, and thematic relevance, and were integrated into the final synthesis of the review.
Development: protective ventilation with low tidal volumes and reduced plateau pressure decreases mortality and pulmonary complications. Prone positioning improves oxygenation and reduces mortality in severe cases. Early use of neuromuscular blockers enhances oxygenation and reduces ventilatory failure rates. Extracorporeal membrane oxygenation proves effective in refractory patients, although associated with risks. Corticosteroids such as dexamethasone have demonstrated clinical benefits, while techniques such as high-frequency oscillatory ventilation and inhaled nitric oxide show inconsistent results. Non-invasive ventilation may be useful in mild to moderate cases, but not in severe ones.
Conclusions: a comprehensive approach combining protective ventilation, prone positioning, and extracorporeal membrane oxygenation in selected cases constitutes the most effective strategy to improve survival and reduce complications in these patients.
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