Pharmacological therapy for acute respiratory distress syndrome.
Acute respiratory distress syndrome (ARDS) is an Inflammatory process caused by a variety of direct and indirect injuries to the lungs. Despite improvements in supportive care and advances in ventilator management, mortality in patients with ARDS remains high. Multiple pharmacological interventions have been investigated but have not shown improved survival. Clinical trials using corticosterolds, prostaglandins, nitric oxide, prostacyclin, surfactant, lisofylline, ketoconazole, N-acetylcystelne, and fish oil have been unable to show a statistically significant Improvement in patient mortality. As more is understood about the pathophyslology of ARDS, treatment strategies such as increasing alveolar fluid clearance through activation of sodium channels, enhancing repair of alveolar epithelium with growth factors, inhibiting fibrin deposition, blocking proinflammatory transcription factors, preventing the effect of potent vasocontrictors such as endothelin, and using antibodies against key inflammatory cytokines are being explored. This review focuses on the pharmacological treatments studied clinically, proposed reasons for their lack of success, and new concepts emerging in ARDS therapy.
Jain
Raksha
R
Department of Internal Medicine, Pulmonary and Critical Care Division, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390-9034, USA.
DalNogare
Anthony
A
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005395:Fish Oils / Q000627:therapeutic use; D006801:Humans; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D017211:Treatment Failure; D014665:Vasodilator Agents / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D000975:Antioxidants; D004791:Enzyme Inhibitors; D005395:Fish Oils; D011663:Pulmonary Surfactants; D014665:Vasodilator Agents