American journal of respiratory and critical care medicine
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Recently there was yet another clinical trial using antioxidants that failed in patients with critical illness. In this perspective, we suggest that antioxidants likely interfere with the normal immune response, thus contributing to the lack of efficacy in patients with critical illness.
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Am. J. Respir. Crit. Care Med. · Dec 2013
ReviewProne Position in Acute Respiratory Distress Syndrome: Rationale, Indications and Limits.
In the prone position, computed tomography scan densities redistribute from dorsal to ventral as the dorsal region tends to reexpand while the ventral zone tends to collapse. Although gravitational influence is similar in both positions, dorsal recruitment usually prevails over ventral derecruitment, because of the need for the lung and its confining chest wall to conform to the same volume. The final result of proning is that the overall lung inflation is more homogeneous from dorsal to ventral than in the supine position, with more homogeneously distributed stress and strain. ⋯ Single-patient and meta-analyses drawing from the four major trials showed significant survival benefit in patients with PaO2/FiO2 lower than 100. The latest PROSEVA (Proning Severe ARDS Patients) trial confirmed these benefits in a formal randomized study. The bulk of data indicates that in severe acute respiratory distress syndrome, carefully performed prone positioning offers an absolute survival advantage of 10-17%, making this intervention highly recommended in this specific population subset.