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Acute respiratory distress syndrome: Investigational or ineffective pharmacotherapy in adults

Author
Mark D Siegel, MD
Section Editor
Polly E Parsons, MD
Deputy Editor
Geraldine Finlay, MD

INTRODUCTION

Therapy for patients with acute respiratory distress syndrome (ARDS) is supportive, aimed at improving gas exchange and preventing complications while the underlying condition that precipitated ARDS is addressed. Potential ARDS-specific pharmacotherapies are being evaluated, although none are currently recommended as routine therapy because patient-important effects are uncertain [1].

Investigational and ineffective medical therapies for ARDS are reviewed here. The pathogenesis of ARDS as well as mechanical ventilation strategies and supportive care for ARDS are discussed in separate reviews. (See "Acute respiratory distress syndrome: Epidemiology, pathophysiology, pathology, and etiology in adults" and "Acute respiratory distress syndrome: Supportive care and oxygenation in adults" and "Mechanical ventilation of adults in acute respiratory distress syndrome".)

CLINICAL TRIALS LINK

Numerous trials investigate novel medical therapies and ventilatory interventions for patients with ARDS. These trials have frequent status updates and can be readily accessed at the US National Institute of Health.  

THERAPIES FOR PREVENTION

Few trials have rigorously examined strategies to prevent ARDS. Aspirin has no proven benefit and trials of inhaled glucocorticoids and beta-2 agonist combinations are awaited.

Aspirin — Preclinical and clinical observational studies of aspirin, as an antiplatelet and anti-inflammatory agent, have suggested a potential role for it in the prevention and treatment of ARDS [2-6]. However, in a randomized trial (LIPS-A) of 390 patients at risk of developing ARDS, aspirin was reported to be of no benefit in preventing ARDS [7]. Aspirin was administered at 325 mg followed by 81 mg daily for seven days following presentation to the emergency department, and compared with placebo, and had no effect on the incidence of ARDS at one week (approximately 10 percent in each group). However, the lower than expected rate of ARDS in this study suggested a more modest severity of illness than anticipated, which may have limited the ability to detect a study drug effect.

             

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Literature review current through: Nov 2016. | This topic last updated: Tue Nov 15 00:00:00 GMT+00:00 2016.
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