tailieunhanh - Báo cáo khoa học: "Recently published papers: Therapies failed, disputed, and beneficent"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Recently published papers: Therapies failed, disputed, and beneficent. | Available online http content 11 3 143 Commentary Recently published papers Therapies failed disputed and beneficent Gareth Williams University Hospitals of Leicester Leicester Royal Infirmary Leicester LE1 5WW UK Corresponding author Gareth Williams Published 18 June 2007 This article is online at http content 11 3 143 2007 BioMed Central Ltd Critical Care 2007 11 143 doi cc5931 Abstract A recent meta-analysis puts another nail in the coffin of a therapy that held great promise for management of acute respiratory distress syndrome. Two papers further highlight the growing controversy surrounding the safety profile of drotrecogin alfa activated and increase the clamour for a new independent trial. Also covered are steroids and their role in preventing postoperative atrial fibrillation and success in instituting hypothermia after cardiac arrest. Finally which form of renal replacement therapy should we be using in the intensive care unit Nitric oxide a promising therapy laid to rest In 1976 Ashbaugh first described acute lung injury acute respiratory distress syndrome. Our subsequent understanding of the underlying pathophysiology has grown enormously and led to the development of many novel therapies. However the high mortality rate has changed little in 40 years. Inhaled nitric oxide NO was one such therapy. It seemed perfect being a selective pulmonary vasodilator resulting in reversal of pulmonary shunt reduction in pulmonary artery pressure and improved right ventricular function not to mention its inhibition of platelet aggregation and neutrophil adhesion. The clever money was on NO. Sadly all that sparkles is not gold. A multitude of studies have simply failed to demonstrate improved outcomes. Despite this its clinical application has continued albeit somewhat piecemeal. In April the British Medical Journal published a systematic review and meta-analysis on the effect of NO in acute lung injury 1 .