[Sedation an acute respiratory distress syndrome].
OBJECTIVE
To assess the role of sedation and myorelaxant agents in acute respiratory distress syndrome (ARDS) and to propose an updated management according to recent literature. EXTRACTION OF DATA: From Medline and Cochrane database of English and French language articles. Keywords were: acute respiratory distress syndrome, acute lung injury, general anaesthetics, inhalation, intravenous anaesthetics and intensive care. Selection of original articles, reviews and expert reports. Case reports have been included.


OBJECTIVE
ARDS is a clinical picture in which respiratory constraints are major because of hypoxemia. To insure correct haematosis, mechanical ventilation has to be considered. It constitutes, then, the most frequent indication of sedation in the intensive care unit. The objectives are to help the ventilation of lungs and to improve gas exchange, by controlling agitation, fight against ventilation and to reduce mechanical ventilation associated injuries. In this situation, use of myorelaxant agents is aimed at facilitating synchronization of the patient with his/her ventilator and serves to improve oxygenation during the early inflammatory phase of ARDS. Several mechanisms may enflame this improvement of oxygenation. One of the most probable effect on optimization is the possibility of optimize protective ventilation at the cares phase of ARDS and to reduce mechanical ventilation-associated injuries.


CONCLUSIONS
With regard to benefits and inconvenient, sedation is considered as a treatment of ARDS. Its goals are the well being of patient and his/her adaptation to ventilator, but also the prevention on mechanical ventilation associated injuries. Hence, most authors suggest using a deep sedation at the early phase of ARDS. In this contact, use of myorelaxant agent is an intersecting adjuvant if sedation is not enough. The benefit is terms of survival and outcome remains to show.
Boyadjiev
I
I
Département d'anesthésie et de réanimation, hôpital Nord, boulevard Pierre-Dramard, 13915 Marseille cedex 20, France.
Albanèse
J
J
D000777:Anesthetics / Q000008:administration & dosage / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods*; D054810:Deep Sedation / Q000379:methods*; D004359:Drug Therapy, Combination; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018836:Inflammation Mediators / Q000378:metabolism; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000009:adverse effects; D012128:Respiratory Distress Syndrome / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D013312:Stress, Physiological / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control
D000777:Anesthetics; D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives; D018836:Inflammation Mediators; D009465:Neuromuscular Agents; D003473:Neuromuscular Nondepolarizing Agents