Pulmonary disease

Question 1

What is the suggested treatment in patients with Pulmonary hypertension who, in the absence of right-sided heart failure or contraindications to CCB therapy, demonstrate acute vasoreactivity?

Answer 1

nifedipine or diltiazem, or amlodipine

at high doses 120–240 mg for nifedipine, 240–720 mg for diltiazem and up to 20 mg for amlodipine

Question 2

What is the treatment for naive PAH patients with WHOFC II and III.

Answer 2

Initial combination therapy with Ambrisentan and Tadalafil to improve 6 Mile Walking Distance (American college for chest physicians)

Question 3

ACUARYS trial, in early within 48hrs ARDs , 2010:
Cisatracurium in sever early P:F ratio less 150
ARDs in 339 patients

Answer 3

in patient with sever ARDs , Cisatracurium for 48hrs decreased 90 days mortality, although analysis was limited by unbalanced baseline characteristics.

Question 4

ROSE trial in 2019 in patients 1006 patients with moderate to sever ARDS with P:F ratio less 150

Answer 4

Cisatracurium for 48hrs with deep sedation didn’t reduce 90dys mortality compared to usual care with lighter sedation, and ICU-acquired weakness and cardiovascular adverse effects were more common in Cisatracurium arm.