Recent developments in the management of acute respiratory distress syndrome in adults.
OBJECTIVE
Recent developments in the management of acute respiratory distress syndrome (ARDS) in adults are reviewed.


CONCLUSIONS
Corticosteroids have been extensively studied in ARDS; however, they have not demonstrated clear benefit in patients with ARDS. Some trials have found increased complications and mortality related to corticosteroid use. The use of conservative fluid management has been associated with significant reductions in morbidity, highlighting the need to avoid fluid over-administration in patients with ARDS. A number of ventilatory strategies have also been studied. Studies have found that higher positive end-expiratory pressure settings do not appear to be harmful in patients with ARDS. In an effort to prevent alveolar overdistention, low tidal volume and plateau pressure ventilation is increasingly being used in patients with acute lung injury (ALI). Given the increasing evidence supporting the use of lower tidal volume ventilation, this strategy has become the new standard of care in patients with suspected ALI and ARDS. No clear benefit has been shown in the treatment of ARDS with nitric oxide and surfactant. Prostaglandins and acetylcysteine are not considered useful in the treatment of ARDS, while no conclusions can be drawn regarding the benefits of albuterol on mortality in patients with ARDS. The use of prone positioning should be discouraged in the treatment of ARDS based on its associated risks.


CONCLUSIONS
Early administration of moderate-dosage corticosteroids likely helps decrease the time of ventilator dependence and duration of intensive care unit stay. Conservative fluid management and low tidal volume ventilation are becoming increasingly widespread in the management of patients with ARDS. Nitric oxide, surfactant, prostaglandins, albuterol, acetylcysteine, and prone positioning have not been shown to be beneficial in the treatment of ARDS.
Bream-Rouwenhorst
Heather R
HR
Veterans Affairs Medical Center, Iowa City, IA, USA.
Beltz
Elizabeth A
EA
Ross
Mary B
MB
Moores
Kevin G
KG
D000111:Acetylcysteine / Q000627:therapeutic use; D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000420:Albuterol / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D005100:Expectorants / Q000627:therapeutic use*; D005440:Fluid Therapy; D006801:Humans; D009569:Nitric Oxide / Q000627:therapeutic use; D016684:Prone Position; D011453:Prostaglandins / Q000627:therapeutic use; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D013990:Tidal Volume
D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D005100:Expectorants; D011453:Prostaglandins; D011663:Pulmonary Surfactants; D009569:Nitric Oxide; D000420:Albuterol; D000111:Acetylcysteine