Pharmacological treatments for acute respiratory distress syndrome.
OBJECTIVE
Studies of the pharmacologic management of acute respiratory distress syndrome (ARDS) have yielded conflicting results. The purpose of this review is to discuss recent pharmacologic trials in ARDS, using the conceptual framework of ARDS as a heterogeneous disease.


RESULTS
Whereas most drug trials in ARDS have been negative, some studies suggest that targeting therapies at subgroups of patients may be successful. Proposed subgroups include early versus late-phase ARDS, direct versus indirect lung injury, and patients with altered coagulation. Corticosteroids have beneficial short-term effects when given at low or moderate doses sooner than 2 weeks but appear to be harmful if initiated later and are of unclear benefit if lung protective ventilation is also used. Surfactant may be helpful in patients with direct lung injury. Anticoagulants and vasodilators may have a greater chance for success in the subset of patients with vascular disease and a high dead-space fraction may identify such a population.


CONCLUSIONS
ARDS is a heterogeneous syndrome. Failure to target subgroups more likely to benefit from specific therapies may be one explanation for largely disappointing trial results so far.
Frank
Angela J
AJ
Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Thompson
B Taylor
BT
D000305:Adrenal Cortex Hormones / Q000494:pharmacology / Q000627:therapeutic use; D015415:Biomarkers; D002986:Clinical Trials as Topic; D006801:Humans; D055370:Lung Injury; D053491:Proteinase Inhibitory Proteins, Secretory / Q000494:pharmacology / Q000627:therapeutic use; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000503:physiopathology
D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D053491:Proteinase Inhibitory Proteins, Secretory