title: Preventing ARDS: progress, promise, and pitfalls.
abstract: Advances in critical care practice have led to a substantial decline in the incidence of ARDS over the past several years. Low tidal volume ventilation, timely resuscitation and antimicrobial administration, restrictive transfusion practices, and primary prevention of aspiration and nosocomial pneumonia have likely contributed to this reduction. Despite decades of research, there is no proven pharmacologic treatment of ARDS, and mortality from ARDS remains high. Consequently, recent initiatives have broadened the scope of lung injury research to include targeted prevention of ARDS. Prediction scores have been developed to identify patients at risk for ARDS, and clinical trials testing aspirin and inhaled budesonide/formoterol for ARDS prevention are ongoing. Future trials aimed at preventing ARDS face several key challenges. ARDS has not been validated as an end point for pivotal clinical trials, and caution is needed when testing toxic therapies that may prevent ARDS yet potentially increase mortality.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Beitler
authors.affiliation: Biostatistics Center, Department of Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: David A
authors.initials: DA
authors.lastname: Schoenfeld
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital; Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA. Electronic address: tthompson1@partners.org.
authors.forename: B Taylor
authors.initials: BT
authors.lastname: Thompson
mesh_terms: D003422:Critical Care / Q000379:methods*; D006801:Humans; D015994:Incidence; D055370:Lung Injury / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy