What is the treatment for Acute Respiratory Distress Syndrome (ARDS)?

From the Guidelines

The treatment for Acute Respiratory Distress Syndrome (ARDS) involves a multifaceted approach, including mechanical ventilation strategies that limit tidal volume and inspiratory pressures, as well as the use of corticosteroids, venovenous extracorporeal membrane oxygenation (VV-ECMO), and neuromuscular blockers in selected patients.

Key Recommendations

• Mechanical ventilation: Use strategies that limit tidal volume (4–8 mL/kg predicted body weight) and inspiratory pressures 1.
• Corticosteroids: Use in patients with ARDS (conditional recommendation, moderate certainty of evidence) 1.
• VV-ECMO: Use in selected patients with severe ARDS (conditional recommendation, low certainty of evidence) 1.
• Neuromuscular blockers: Use in patients with early severe ARDS (conditional recommendation, low certainty of evidence) 1.
• Positive end-expiratory pressure (PEEP): Use higher PEEP without lung recruitment maneuvers as opposed to lower PEEP in patients with moderate to severe ARDS (conditional recommendation, low to moderate certainty) 1.

Additional Considerations

• Prone positioning and lung recruitment maneuvers may be considered in selected patients, but their use should be individualized and based on the patient's specific condition 1.
• Extracorporeal membrane oxygenation (ECMO) should be considered in selected patients with reversible disease 1.
• Oxygenation targets and PEEP levels should be individualized in each patient to minimize the risks of ventilator-induced lung injury (VILI) 1.

From the Research

Treatment Options for Acute Respiratory Distress Syndrome (ARDS)

The treatment for ARDS is primarily supportive, with the goal of improving oxygenation and reducing mortality. Some of the key treatment options include:

• Mechanical ventilation with low tidal volumes and high positive end-expiratory pressure (PEEP) to improve lung function and prevent further injury 2, 3, 4
• Prone positioning, which has been shown to improve oxygenation and reduce mortality in severe cases of ARDS 2, 5, 3, 4
• Recruitment maneuvers to promote reopening of collapsed lung alveoli 2, 5
• High-frequency oscillatory ventilation, which may improve oxygenation but has not been shown to improve survival 5, 3
• Extracorporeal membrane oxygenation (ECMO), which can be used as a rescue therapy in patients with severe ARDS who do not respond to other treatments 2, 5, 3
• Supportive measures such as attention to fluid balance, restrictive transfusion strategies, and minimization of sedatives and neuromuscular blocking agents 2, 4
• Inhaled bronchodilators such as inhaled nitric oxide and prostaglandins, which may confer short-term improvement in oxygenation but have not been shown to improve survival 2, 5
• Corticosteroids, which may be beneficial in reducing mortality in certain cases of ARDS 2

Pharmacological Therapies

Several pharmacological therapies have been investigated for the treatment of ARDS, including:

• Keratinocyte growth factor, which has not been shown to improve outcomes 3
• Beta-2 agonists, which have not been shown to improve outcomes 3
• Aspirin, which has not been shown to improve outcomes 3
• Mesenchymal stem cells, which are being investigated in ongoing clinical trials 3
• Vitamin C, which is being investigated in ongoing clinical trials 3

Ongoing Research and Emerging Therapies

Ongoing research is focused on individualizing treatment for ARDS patients based on their specific genotypes and underlying pathophysiological mechanisms 6. Emerging therapies, such as extracorporeal carbon dioxide removal, are also being investigated 3.