From the Guidelines
Respiratory Distress Syndrome (RDS) should be diagnosed and treated with a focus on respiratory support, including the use of corticosteroids, venovenous extracorporeal membrane oxygenation, neuromuscular blockers, and positive end-expiratory pressure (PEEP), as recommended by the most recent guidelines 1. The diagnosis of RDS involves identifying patients with symptoms of respiratory distress, such as dyspnea, hypoxemia, and decreased lung compliance. Key aspects of treatment include:
- The use of corticosteroids for patients with ARDS, as suggested by the American Thoracic Society clinical practice guideline 1
- The use of venovenous extracorporeal membrane oxygenation in selected patients with severe ARDS, as recommended in the updated guideline 1
- The use of neuromuscular blockers in patients with early severe ARDS, as suggested by the guideline 1
- The use of higher PEEP without lung recruitment maneuvers as opposed to lower PEEP in patients with moderate to severe ARDS, as recommended in the guideline 1 Supportive care is also crucial and includes maintaining optimal oxygenation, careful fluid management, temperature regulation, and nutritional support. It is essential to note that individual patient and illness characteristics should be factored into clinical decision making and implementation of these recommendations while additional evidence is generated from much-needed clinical trials 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
CUROSURF® (poractant alfa) Intratracheal Suspension is indicated for the rescue treatment of Respiratory Distress Syndrome (RDS) in premature infants. CUROSURF reduces mortality and pneumothoraces associated with RDS.
The diagnosis of Respiratory Distress Syndrome (RDS) is not directly addressed in the provided drug labels. The treatment for RDS is the administration of CUROSURF (poractant alfa) Intratracheal Suspension, which is indicated for the rescue treatment of RDS in premature infants, and has been shown to reduce mortality and pneumothoraces associated with RDS 22.
From the Research
Diagnosis of Respiratory Distress Syndrome (RDS)
- RDS is characterized by inflammation-induced disruption of the alveolar endothelial-epithelial barrier, resulting in increased permeability and surfactant dysfunction, followed by alveolar flooding and collapse 3
- The diagnosis of RDS is based on clinical presentation, including symptoms such as shortness of breath, chest tightness, and hypoxemia 4, 5
Treatment of Respiratory Distress Syndrome (RDS)
- Mechanical ventilation is the main therapeutic modality for RDS, with the goal of providing a reasonable gas exchange while minimizing ventilator-induced lung injury (VILI) 4, 5, 3
- Ventilator settings should be individualized to improve patient-ventilator synchrony and reduce VILI, with a tidal volume between 6-8 ml/kg of predicted body weight and a plateau pressure < 30 cmH₂O 3
- Positive end-expiratory pressure (PEEP) can be individualized by titrating to best respiratory system compliance, or by using advanced methods such as electrical impedance tomography or esophageal manometry 4, 3
- Adjunctive therapies, such as recruitment maneuvers, inhaled pulmonary vasodilators, neuromuscular blockers, or glucocorticoids, may be applied judiciously to improve oxygenation, but do not clearly reduce mortality 4, 6
- Surfactant replacement therapy has been shown to be effective in the treatment of neonatal RDS and has become a standard of care in neonatal intensive care units 7
- Pharmacological treatments, such as cis-atracurium, have shown promise in reducing mortality in patients with RDS, but effective pharmacotherapy for RDS remains extremely limited 6