Materiały źródłowe

• #1 Acute Respiratory Distress Syndrome: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0615/p730.html

  Acute respiratory distress syndrome (ARDS) is noncardiogenic pulmonary edema that manifests as rapidly progressive dyspnea, tachypnea, and hypoxemia. […] Treatment of ARDS is supportive and includes mechanical ventilation, prophylaxis for stress ulcers and venous thromboembolism, nutritional support, and treatment of the underlying injury. Low tidal volume and high positive end-expiratory pressure improve outcomes. Prone positioning is recommended for some moderate and all severe cases. […] Treatment of ARDS is generally supportive, consisting of mechanical ventilation, prevention of stress ulcers and venous thromboembolism, and nutritional support while addressing the underlying etiology. […] Although mild cases of ARDS may respond to noninvasive ventilation, most patients require sedation, intubation, and ventilation while the underlying injury is treated.

• #1 Acute Respiratory Distress Syndrome (ARDS)

  https://my.clevelandclinic.org/health/diseases/15283-acute-respiratory-distress-syndrome-ards

  Survival rates for ARDS are around 55% to 70% when treatment is prompt. If treatment is delayed or other organs begin to fail, survival rates are lower. […] ARDS can be life-threatening and scary. But improved care and ventilator treatments including having people lay face down (prone) to improve oxygen flow are helping more people survive and reduce ARDS complications. The outlook is typically better in people younger than 65 and when trauma or a blood transfusion causes ARDS. […] Yes, your lungs can recover from ARDS. The exact amount of time varies depending on how much lung damage you have. Most people regain their lung function within two years, although several factors go into that estimate.

• #1 ARDS – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ards/diagnosis-treatment/drc-20355581

  The first goal in treating ARDS is to improve the levels of oxygen in your blood. Without oxygen, your organs can’t work properly. […] To get more oxygen into your bloodstream, your healthcare professional likely will use: […] For milder symptoms or as a short-term treatment, oxygen may be delivered through a mask that fits tightly over your nose and mouth. […] Most people with ARDS need the help of a machine to breathe. A mechanical ventilator pushes air into your lungs and forces some of the fluid out of the air sacs. […] ECMO may be an option for severe ARDS when other treatment options, such as mechanical ventilation, don’t work. ECMO takes over for the heart, lungs or both for a limited time while the lungs rest and heal. This treatment can help when the body can’t provide the tissues with enough oxygen.

• #1 Acute respiratory distress syndrome Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/acute-respiratory-distress-syndrome

  ARDS often needs to be treated in an intensive care unit (ICU). […] The goal of treatment is to provide breathing support and treat the cause of ARDS. This may involve medicines to treat infections, reduce inflammation, and remove fluid from the lungs. […] A ventilator is used to deliver high doses of oxygen and positive pressure to the damaged lungs. People often need to be deeply sedated with medicines. During treatment, your health care providers make every effort to protect your lungs from further damage. Certain ways of using the ventilator can protect your lungs better and improve chances of recovery. Treatment is mainly supportive until the lungs recover. […] Sometimes, a treatment called extracorporeal membrane oxygenation (ECMO) is done. During ECMO, blood is filtered through a machine to provide oxygen and remove carbon dioxide.

• #1 Acute Respiratory Distress Syndrome (ARDS)

  https://my.clevelandclinic.org/health/diseases/15283-acute-respiratory-distress-syndrome-ards

  Acute respiratory distress syndrome (ARDS) is a lung injury that happens when fluids build up in small air sacs (alveoli) in your lungs. ARDS prevents your lungs from filling up with air and causes dangerously low oxygen levels in your blood (hypoxia). […] Treatment for ARDS involves increasing oxygen levels in your blood to prevent organ failure. People with ARDS need a mechanical ventilator and/or oxygen therapy to improve blood oxygen levels. They also need help to open up the airways that have closed due to damage. […] Your healthcare provider may take steps to minimize complications from ARDS. These include: Sedation to manage pain and sedatives help you relax. Placing you in a prone position (on your stomach), instead of on your back. Breathing tests to determine when its safe to remove the tube and ventilator. Blood thinners to prevent clots. Diuretics to remove extra fluid from your body. Medications to minimize fluid buildup in your lungs. Antibiotics to prevent or treat infection. Active mobility and physical therapy to prevent muscle weakness. Pulmonary rehabilitation to help strengthen your lungs and increase lung capacity.

• #1 ARDS Treatment and Recovery | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/ards/ards-treatment-and-recovery

  ARDS is a serious condition that can be frightening for patients and their loved ones. […] There is no cure for ARDS at this time. Treatment focuses on supporting the patient while the lungs heal. The goal of supportive care is getting enough oxygen into the blood and delivered to your body to prevent damage and removing the injury that caused ARDS to develop. […] All patients with ARDS will require extra oxygen. […] A ventilator is a machine used to open airspaces that have shut down and help with the work of breathing. […] When oxygen and ventilator therapies are at high levels and blood oxygen is still low, ARDS patients are sometimes turned over on their stomach to get more oxygen into the blood. […] To relieve shortness of breath and prevent agitation, the ARDS patient usually needs sedation.

• #1 Acute Respiratory Distress Syndrome – Treatment | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/ards/treatment

  The goal of treatment for ARDS is to improve oxygen levels and treat the underlying cause. Oxygen therapy is the main treatment for ARDS. Other treatments aim to prevent complications and make you comfortable. […] Oxygen therapy is a treatment that delivers oxygen for you to breathe. […] Oxygen therapy is generally safe. […] Depending on how serious your symptoms are, your doctor may suggest a device or machine to support your breathing: Noninvasive ventilation, such as use of bilevel positive airway pressure (BiPAP) or continuous positive airway pressure (CPAP) machines, which are electronic breathing devices that help keep your airways open by blowing air through a face mask. […] A ventilator may help restore your blood oxygen levels. […] Your doctor may recommend medicines to relieve symptoms, treat the underlying cause, or prevent complications from being in a hospital: Acid-reducing medicines prevent stress ulcers, which can cause bleeding in the intestines.

• #1 Acute Respiratory Distress Syndrome (ARDS) Treatment Options | Temple Health

  https://www.templehealth.org/services/conditions/acute-respiratory-distress-syndrome/treatment-options

  Patients benefit from the experience and focused attention of the whole team, who collaborate to deliver specialized quality care. […] ARDS treatment focuses on supporting the patient while the lung heals, and usually involves some combination of oxygen therapy, ventilator support, prone positioning, and extra-corporeal membrane oxygenation (ECMO). […] The most common treatment for ARDS is oxygen therapy. This involves delivering extra oxygen to patients, through a mask, nasal cannula (two small tubes that enter the nose), or a tube inserted directly into the windpipe. […] Ventilator support: All patients with ARDS need oxygen therapy, as noted above. Oxygen alone is usually not enough, and patients will likely need to be supported by a mechanical ventilator too. […] Prone positioning: Hospitalized patients are typically in bed on their backs. However, lying facedown (prone) may help improve oxygen levels in the blood and increase survival in patients with ARDS. […] ECMO: a complex treatment that takes blood outside of the patients body, adds oxygen and removes carbon dioxide, and then returns it.

• #1 Acute Respiratory Distress Syndrome (ARDS) Treatment & Management: Approach Considerations, Pharmacotherapy, Fluid Management

  https://emedicine.medscape.com/article/165139-treatment

  The use of a conservative fluid management approach has been called into question by the long-term follow-up of a subset of survivors of the Fluid and Catheter Treatment Trial (FACTT). […] Although mortality in the survivors was similar regardless of fluid management strategy, and the conservative fluid management group required about 18 hours less mechanical ventilatory support, cognitive function was markedly impaired in the conservative fluid group compared with the liberal fluid group, with an adjusted odds ratio of 3.35. […] Patients who have a diminished level of consciousness, vomiting, upper GI bleeding, or other conditions that increase aspiration risk are not candidates for NIPPV. […] The goals of mechanical ventilation in ARDS are to maintain oxygenation while avoiding oxygen toxicity and the complications of mechanical ventilation.

• #1 Acute Respiratory Distress Syndrome (ARDS) Treatment & Management: Approach Considerations, Pharmacotherapy, Fluid Management

  https://emedicine.medscape.com/article/165139-treatment

  Experimental studies have shown that mechanical ventilation may promote a type of acute lung injury termed ventilator-associated lung injury. […] A protective ventilation strategy using low tidal volumes and limited plateau pressures improves survival when compared with conventional tidal volumes and pressures. […] In an ARDS Network study, patients with ALI and ARDS were randomized to mechanical ventilation either at a tidal volume of 12 mL/kg of predicted body weight and an inspiratory pressure of 50 cm water or less or at a tidal volume of 6 mL/kg and an inspiratory pressure of 30 cm water or less; the study was stopped early after interim analysis of 861 patients demonstrated that subjects in the low-tidal-volume group had a significantly lower mortality rate (31% versus 39.8%). […] Thus, mechanical ventilation with a tidal volume of 6 mL/kg predicted body weight is recommended, with adjustment of the tidal volume to as low as 4 mL/kg if needed to limit the inspiratory plateau pressure to 30 cm water or less.

• #1 Management of severe acute respiratory distress syndrome: a primer | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-023-04572-w

  In select, refractory cases, the addition of V-V ECMO improves gas exchange and modestly improves survival by allowing for lung rest. […] Traditional treatment of severe ARDS is supportive, anchored by lung protective mechanical ventilation, proning, and conservative fluid management. […] Low tidal volume ventilation using either pressure-assist control (PC) or volume-assist control (VC) modes significantly improves mortality in ARDS. […] The landmark ARMA trial demonstrated that a tidal volume of 6 cc/kg ideal body weight (IBW) compared to 12 cc/kg IBW reduced mortality (31% vs. 40%) and increased ventilator-free days. […] High driving pressures (15-17 cm H2O) are independently linked to ARDS mortality. […] The proposed benefits to APRV include allowing for spontaneous breathing, decreased work of breathing, and less dyssynchrony (and therefore less use of sedatives and paralytics).

• #1 Acute Respiratory Distress Syndrome: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0615/p730.html

  Starting with low tidal volumes of 6 mL per kg of predicted body weight is superior to starting with traditional volumes of 10 to 15 mL per kg. […] Higher PEEP values (12 cm H2O or higher) are associated with decreased mortality when compared with values of 5 to 12 cm H2O and should be used in patients with moderate or severe ARDS. […] Prone positioning requires moving a patient from the traditional supine position while maintaining the integrity of the patient-ventilator circuit and all venous, arterial, urinary, and other access lines. […] Inhaled nitric oxide is a pulmonary arterial vasodilator that may improve perfusion in ventilated areas and moderate the harmful inflammatory response that occurs in ARDS. […] Patients with ARDS should receive low-molecular-weight heparin, low-dose unfractionated heparin, or fondaparinux (Arixtra) to prevent venous thromboembolism, unless these agents are contraindicated. […] The role of corticosteroids is controversial. […] A randomized controlled trial found that intravenous pantoprazole (Protonix), 40 mg per day, decreased clinically important gastrointestinal bleeding compared with placebo.

• #1 Management of severe acute respiratory distress syndrome: a primer | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-023-04572-w

  This narrative review explores the physiology and evidence-based management of patients with severe acute respiratory distress syndrome (ARDS) and refractory hypoxemia, with a focus on mechanical ventilation, adjunctive therapies, and veno-venous extracorporeal membrane oxygenation (V-V ECMO). […] The mainstay of treatment to improve survival and ventilator-free days is proning, conservative fluid management, and lung protective ventilation. […] In patients with refractory hypoxemia, salvage modes of ventilation such as high frequency oscillatory ventilation and airway pressure release ventilation are additional options that may be appropriate in select patients. […] Adjunctive therapies also may be applied judiciously, such as recruitment maneuvers, inhaled pulmonary vasodilators, neuromuscular blockers, or glucocorticoids, and may improve oxygenation, but do not clearly reduce mortality.

• #1 Management of severe acute respiratory distress syndrome: a primer | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-023-04572-w

  While APRV may increase mean airway pressures there is less control over tidal volume and minute ventilation. […] Despite its use in ARDS, high quality evidence favoring APRV is lacking, and the available studies reported mixed results. […] High frequency oscillatory ventilation (HFOV) is a mode of IMV that employs a constant airway pressure with oscillations at extreme respiratory frequencies (e.g., 5-15 Hz or 300-900 breaths per minute), delivering tidal volumes well below that of anatomical dead space. […] While HFOV was previously considered a rescue mode of ventilation for severe ARDS, its use has fallen out of favor. […] Prone ventilation improves oxygenation and ventilatory mechanics in many patients with severe ARDS. […] The PROSEVA trial is the most notable study of early proning in patients with moderate-to-severe ARDS (P/F150, FIO260%).

• #1 Acute Respiratory Distress Syndrome (ARDS) Treatment & Management: Approach Considerations, Pharmacotherapy, Fluid Management

  https://emedicine.medscape.com/article/165139-treatment

  The use of paralytics remains controversial. […] Patients with severe ARDS may also benefit from the early use of neuromuscular blocking agents. […] The conclusion was that weakness, injury, and atrophy can occur rapidly in the diaphragms of patients on mechanical ventilation and are significantly correlated with the duration of ventilator support. […] Some 60-75% of patients with ARDS have significantly improved oxygenation when turned from the supine to the prone position. […] Despite improved oxygenation with the prone position, early randomized controlled trials of the prone position in ARDS did not demonstrate improved survival. […] However, a subsequent randomized controlled trial in which patients with severe ARDS were placed in the prone position early and for at least 16 hours a day showed a significant mortality benefit.

• #1 Acute Respiratory Distress Syndrome (ARDS) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/ards

  For ARDS in general and especially with COVID-19, having a patient lie on their belly (on or off a ventilator) can help patients use parts of their lungs that arent used when lying on their back. […] In some cases, if ventilator treatment fails to adequately improve blood oxygen levels or if the patient is unsuited to mechanical ventilation, doctors will place ARDS patients on Extracorporeal Membrane Oxygenation, or ECMO, therapy. In ECMO therapy, a machine takes over the functions usually performed by the lungs, and if necessary, the heart. […] While the mortality rate for ARDS is significant, recent advances in treatment have significantly increased the chances of survival and recovery.

• #1 Acute Respiratory Distress Syndrome (ARDS): Causes, Symptoms & Treatment

  https://www.emedicinehealth.com/acute_respiratory_distress_syndrome/article_em.htm

  What is the treatment for ARDS? […] Persons with ARDS are hospitalized and require treatment in an intensive care unit. […] No specific therapy for ARDS exists. […] Treatment is primarily supportive using a mechanical respirator and supplemental oxygen. […] Intravenous fluids are given to provide nutrition and prevent dehydration and are carefully monitored to prevent fluid from accumulating in the lungs (pulmonary edema). […] Because the infection is often the underlying cause of ARDS, appropriate antibiotic therapy is administered. […] Corticosteroids may sometimes be administered in ARDS or if the patient is in shock, but their use is controversial. […] What medications are used to treat ARDS? […] The following drugs may be administered: […] Antibiotics to treat infection

• #1 Management of severe acute respiratory distress syndrome: a primer | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-023-04572-w

  While paralysis may help to facilitate proning safely, it is not required. […] Acute lung injury during ARDS may be exacerbated by fluid overload. […] The administration of empiric steroids for severe ARDS has remained controversial and clinical trial results have varied significantly. […] Neuromuscular blockade (NMB) improves oxygenation via several mechanisms. […] Several trials have investigated the role of inhaled pulmonary vasodilators in ARDS, notably iNO and inhaled prostaglandins. […] V-V ECMO provides extracorporeal gas exchange in patients with refractory respiratory failure, and plays a critical role in the care of select patients with severe ARDS, though the selection criteria and timing of its use remain controversial. […] While optimal ventilator settings for patients on V-V ECMO are not clear, the use of ECMO allows for lung rest with dramatic reductions in driving pressure, Pplat, and mechanical power, which may reduce ongoing VILI.

• #1 Formal guidelines: management of acute respiratory distress syndrome | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0540-9

  Once tidal volume is set to around 6 mL/kg PBW, plateau pressure should be monitored continuously and should not exceed 30 cmH2O to reduce mortality. […] The experts suggest that tidal volume should not be increased when the plateau pressure is well below 30 cmH2O, except in cases of marked, persistent hypercapnia despite reduction of instrumental dead space and increase of respiratory rate. […] PEEP is an essential component of the management of ARDS and the experts suggest using a value above 5 cmH2O in all patients presenting with ARDS. […] High PEEP should probably be used in patients with moderate or severe ARDS, but not in patients with mild ARDS. […] A neuromuscular blocking agent should probably be considered in ARDS patients with a PaO2/FiO2 ratio150 mmHg to reduce mortality. […] The neuromuscular blocking agent should be administered by continuous infusion early (within 48 h after the start of ARDS), for no more than 48 h, with at least daily evaluation.

• #1 Pharmacological treatments in ARDS; a state-of-the-art update | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-166

  Therefore, in the severely hypoxemic ARDS patient, NMB may permit lower-pressure, lower-tidal volume ventilation with a consequent reduction in ventilator-induced lung injury. […] These beneficial effects led to a multi-center, randomized, placebo-controlled trial to assess the effect of NMB upon mortality. […] This showed that infusion with cisatracuriumbesylate within 48 hours of mechanical ventilation in patients with moderate ARDS improved 90-day survival. […] However, no difference was noted between the intervention and placebo groups until Day 20. […] While promising, the protective effect of neuromuscular blockade needs to be confirmed in a further phase 3 trial. […] Given their effective anti-inflammatory properties, there has been extensive interest in the potential role of corticosteroids in both the prevention and treatment of ARDS.

• #1 Acute Respiratory Distress Syndrome (ARDS) Treatment & Management: Approach Considerations, Pharmacotherapy, Fluid Management

  https://emedicine.medscape.com/article/165139-treatment

  No drug has consistently proved beneficial in the prevention or management of acute respiratory distress syndrome (ARDS). […] Early administration of corticosteroids to septic patients does not prevent the development of ARDS. […] A study by Martin-Loeches et al concluded that the early use of corticosteroids was also ineffective in patients with the pandemic H1N1 influenza A infection, resulting in an increased risk of superinfections. […] More recently, a multi-center randomized controlled trial conducted at 17 ICUs in Spain showed more promising results with corticosteroids. […] The dexamethasone group was administered intravenous (IV) administration of 20 mg once daily five days, which was reduced to 10 mg once daily another 5 days. […] The patients in the dexamethasone group had increased ventilator-free days with a group difference of 4-8 days.

• #1 Managing Acute Respiratory Distress Syndromelogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na56980/2024/01/16/managing-acute-respiratory-distress-syndrome

  This update of a 2017 clinical practice guideline addresses use of steroids and neuromuscular blockade for ARDS patients. […] Administration of steroids is recommended, although without specific guidance on choice of steroid, dose, timing, or duration. The document suggests following steroid recommendations for specific causes of ARDS (e.g., COVID-19, community-acquired pneumonia). […] Neuromuscular blockade (NMB) is recommended in early treatment of patients with severe ARDS (partial pressure of oxygen [PaO2]:fraction of inspired oxygen [FiO2] <100) and courses should be limited to 48 hours or shorter. [...] Venovenous extracorporeal membrane oxygenation (ECMO) now is recommended for select patients with severe ARDS (PaO2:FiO2 <80 or pH <7.25 with PaCO2 ≥60 mm Hg), although with low certainty of evidence.

• #1 ARDS Treatment and Recovery | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/ards/ards-treatment-and-recovery

  Doctors may give ARDS patients a medication called a diuretic to increase urination in hopes of removing excess fluid from the body to help prevent fluid from building up in the lungs. […] ECMO is a very complicated treatment that takes blood outside of your body and pumps it through a membrane that adds oxygen, removes carbon dioxide and then returns the blood to your body. […] ARDS patients may require ventilation for long periods of time. […] It is important to note that most people survive ARDS. They will not require oxygen on a long-term basis and will regain most of their lung function.

• #1 Acute Respiratory Distress Syndrome (ARDS) Treatment & Management: Approach Considerations, Pharmacotherapy, Fluid Management

  https://emedicine.medscape.com/article/165139-treatment

  At 60 days, the placebo group had significantly higher mortality compared to the dexamethasone group (36% vs 21%, respectively). […] Distinguishing between initial fluid resuscitation, as used for therapy of septic shock, and maintenance fluid therapy is important. […] However, several small trials have demonstrated improved outcome for ARDS in patients treated with diuretics or dialysis to promote a negative fluid balance in the first few days. […] An ARDS Clinical Trials Network study of a fluid-conservative strategy versus a fluid-liberal strategy in the management of patients with ARDS or acute lung injury (ALI) found no statistically significant difference in 60-day mortality between the two groups 72 hours after presentation with ARDS. […] However, patients treated with the fluid-conservative strategy had an improved oxygenation index and lung injury score and an increase in ventilator-free days, without an increase in nonpulmonary organ failures.

• #1 Acute respiratory distress syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Acute_respiratory_distress_syndrome

  Appropriate antibiotic therapy is started as soon as culture results are available, or if infection is suspected (whichever is earlier). […] Extracorporeal membrane oxygenation (ECMO) is mechanically applied prolonged cardiopulmonary support. […] Multiple studies have shown the effectiveness of ECMO in acute respiratory failure. […] The combination of hydrocortisone, ascorbic acid, and thiamine also requires further study as of 2018. […] As of 2019, it is uncertain whether or not treatment with corticosteroids improves overall survival. […] Inhaled nitric oxide (NO) selectively widens the lung’s arteries which allows for more blood flow to open alveoli for gas exchange. […] Despite evidence of increased oxygenation status, there is no evidence that inhaled nitric oxide decreases morbidity and mortality in people with ARDS.

• #1 Formal guidelines: management of acute respiratory distress syndrome | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0540-9

  Prone positioning should be used in ARDS patients with PaO2/FIO2 ratio150 mmHg to reduce mortality. […] Sessions of at least 16 consecutive hours should be performed. […] Venovenous extracorporeal membrane oxygenation (ECMO) should probably be considered in cases of severe ARDS with PaO2/FiO2<80 mmHg and/or when mechanical ventilation becomes dangerous because of the increase in plateau pressure and despite optimization of ARDS management including high PEEP, neuromuscular blocking agents, and prone positioning. [...] The decision to use ECMO should be evaluated early by means of contact with an expert center. [...] The experts suggest that inhaled nitric oxide can be used in cases of ARDS with deep hypoxemia despite the implementation of a protective ventilation strategy and prone positioning, and before envisaging use of venovenous ECMO.

• #1 Emerging pharmacological therapies for ARDS: COVID-19 and beyond

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7352097/

  A single IV infusion of allogeneic, bone marrow-derived human MSCs was well tolerated in nine patients with moderate to severe ARDS in a phase 1 dose escalation trial. […] The p38 mitogen-activated protein kinase (MAPK) pathway is activated during cellular stress and drives downstream production of inflammatory cytokines. […] Dilmapimod is a specific p38MAPK inhibitor and potent anti-inflammatory. […] AP-301 (also termed Solnatide) is an activator of alveolar epithelial sodium channels. […] Nebulized AP-301 every 12 h for 7 days was recently shown to decrease extravascular lung water and reduce ventilation pressures in a small phase 2 randomized blinded exploratory study in patients with early ARDS. […] Dysfunctions of coagulation in ARDS play a key role in ARDS pathogenesis. […] The anti-TF drug, ALT-836, was found to be safe when administered to ARDS patients in a phase 1, randomized, placebo-controlled, dose escalation study.

• #1 Acute Respiratory Distress Syndrome – Treatment | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/ards/treatment

  Antibiotics treat or prevent infections. […] Blood thinners stop blood clots from forming or growing larger. […] Muscle relaxants help prevent coughing or gagging while on a ventilator or reduce the amount of oxygen your body needs. […] Sedatives help relieve anxiety, make it easier to breathe on a ventilator, or lower your body’s oxygen needs. […] Your doctor may recommend other treatments, including the following: A feeding tube can ensure you get enough of the right nutrients while you are on a ventilator. […] Blood transfusions treat low hemoglobin levels. […] Extracorporeal membrane oxygenation (ECMO) or a similar device helps when ventilation alone cannot deliver enough oxygen or while a patient waits for a lung transplant. […] Fluid management through an intravenous (IV) line helps restore fluid levels if needed. […] Lying facedown helps get more oxygen to your lungs. […] Physical therapy maintains muscle strength and prevent sores from forming.

• #1 Best Acute Respiratory Distress Syndrome (ARDS) Treatment | ARDS Causes, Symptoms, Therapy & Medications

  https://www.maxhealthcare.in/our-specialities/pulmonology/conditions-treatments/acute-respiratory-distress-syndrome

  Placing patients in the prone (face-down) position can improve oxygenation by redistributing blood flow and reducing pressure on the lungs. Prone positioning is often used as a supportive therapy in patients with moderate to severe ARDS. […] Bronchodilators may be used to help improve airflow in patients with bronchospasm or underlying airway disease. […] While controversial, corticosteroids may be considered in some cases of ARDS, especially if there is evidence of an underlying inflammatory component. […] These medications may be used to support blood pressure and improve tissue perfusion in patients with septic shock or hemodynamic instability. […] Treatment for ARDS is often provided in an intensive care unit (ICU) setting, and management is individualised based on the severity of the condition, underlying cause, and patient’s overall health status. Close monitoring and multidisciplinary care are essential for optimising outcomes in patients with ARDS.

• #1 ARDS – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ards/diagnosis-treatment/drc-20355581

  For some people with ARDS, positioning on the stomach what’s known as a prone position during mechanical ventilation may make more oxygen available to the lungs. […] Carefully managing the amount of IV fluids given to people with ARDS is very important. Giving too much fluid can make more fluid build up in the lungs. Giving too little fluid can strain the heart and other organs, leading to shock. […] People with ARDS usually get medicine to: […] When other treatments don’t help, lung transplant may be an option for some carefully chosen people who have ARDS. Usually, these are people who were healthy before they developed severe ARDS. Because lung transplant is such a hard process, it should be done at a center that has highly skilled, experienced surgeons and transplant teams.

• #1 ARDS (Acute Respiratory Distress Syndrome)

  https://www.svhlunghealth.com.au/conditions/ards-acute-respiratory-distress-syndrome

  ARDS requires urgent, specialist medical care in a hospital. The main aims of treatment are: […] Treatment therapies for ARDS include: […] Antibiotics to help prevent and treat infections, especially if a ventilator is required (as ventilator use can increase the risk for infection) […] Blood thinning medications and aids (such as compression stockings) to help reduce the risk of blood clots, which are more likely after long periods of rest […] Nutritional support people with ARDS are more likely to suffer from malnutrition, therefore additional nutrition can be given via feeding tubes […] Oxygen therapy oxygen is delivered through a face mask, nasal prongs or a breathing tube connected to a ventilator machine (also known as life support), providing additional oxygen to your lungs and other organs. In the most severe cases, lung bypass using extra-corporeal membrane oxygenation may be required

• #1 Acute Respiratory Distress Syndrome (ARDS) Treatment & Management: Approach Considerations, Pharmacotherapy, Fluid Management

  https://emedicine.medscape.com/article/165139-treatment

  In patients requiring prolonged mechanical ventilation, tracheostomy allows the establishment of a more stable airway, which may allow for mobilization of the patient and, in some instances, may facilitate weaning from mechanical ventilation. […] A large multicenter trial in the 1970s demonstrated that extracorporeal membrane oxygenation (ECMO) did not improve the mortality rate in ARDS patients. […] However, during the H1N1 flu epidemic in 2009, ECMO appeared to improve survival in patients with H1N1-associated ARDS who could not be oxygenated with conventional mechanical ventilation. […] Nutritional support after 48-72 hours of mechanical ventilation usually is recommended. […] A low-carbohydrate high-fat enteral formula including anti-inflammatory and vasodilating components (eicosapentaenoic acid and linoleic acid) along with antioxidants has been demonstrated in some studies to improve outcome in ARDS.

• #1 Acute Respiratory Distress Syndrome (ARDS) Treatment & Management: Approach Considerations, Pharmacotherapy, Fluid Management

  https://emedicine.medscape.com/article/165139-treatment

  The main concerns are missing a potentially treatable underlying cause or complication of ARDS. […] In these critically ill patients, pay careful attention to early recognition of potential complications in the intensive care unit (ICU), including pneumothorax, IV line infections, skin breakdown, inadequate nutrition, arterial occlusion at the site of intra-arterial monitoring devices, DVT and pulmonary embolism (PE), retroperitoneal hemorrhage, gastrointestinal (GI) hemorrhage, erroneous placement of lines and tubes, and the development of muscle weakness. […] In addition, preventing complications associated with prolonged mechanical ventilation and ICU stay can include deep venous thrombosis (DVT) prophylaxis, stress ulcer prophylaxis, early mobilization, minimizing sedation, turning and skin care, and strategies to prevent ventilator-induced pneumonia, such as elevation of the head of the bed and use of a subglottic suction device.

• #1 Emerging pharmacological therapies for ARDS: COVID-19 and beyond

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7352097/

  ARDS, first described in 1967, is the commonest form of acute severe hypoxemic respiratory failure. […] Despite considerable advances in our knowledge regarding the pathophysiology of ARDS, insights into the biologic mechanisms of lung injury and repair, and advances in supportive care, particularly ventilatory management, there remains no effective pharmacological therapy for this syndrome. […] The purpose of the review is to critically appraise the current status of promising emerging pharmacological therapies for patients with ARDS and potential impact of these and other emerging therapies for COVID-19-induced ARDS. […] Several therapies show promise in earlier and later phase clinical testing, while a growing pipeline of therapies is in preclinical testing. […] Attention has been focused on the potential to identify biologically homogenous subtypes within ARDS, to enable us to target more specific therapies precision medicines.

• #1 Emerging pharmacological therapies for ARDS: COVID-19 and beyond

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7352097/

  In a small phase 2 trial, patients with ARDS treated with ulinastatin injection demonstrated improved lung oxygenation and function and reduced duration of mechanical ventilation and reduced hospital stays compared to standard care. […] Vitamin C is recognized for its antioxidant and reparative properties. […] In a phase 2 study of patients with sepsis-induced ARDS, vitamin C did not reduce SOFA scores, which was the primary outcome, nor did it have an effect on biomarkers, even at high doses. […] Carbon monoxide (CO) is a gas produced endogenously by heme oxygenase, which protects against oxidative stress, cell death and suppresses inflammation. […] A phase 2 efficacy study of CO in ARDS is currently recruiting. […] MSCs have immunomodulatory and pro-reparative effects and show efficacy in preclinical models of ARDS.

• #1 Clinical Trial for Acute Respiratory Distress Syndrome – MultiStem Therapy Tested as ARDS Treatment | University Hospitals

  https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2019/06/clinical-trial-seeks-potential-ards-treatment

  For the more than 200,000 patients diagnosed every year with Acute Respiratory Distress Syndrome (ARDS), there are few treatment options. […] To that end, UH is participating in a Phase I/II clinical trial called MultiStem Therapy in Acute Respiratory Distress Syndrome (MUST-ARDS). […] MultiStem is a bone-marrow cell therapy product derived from multi-potent adult progenitor cells, Dr. Jacono explains. […] In the MUST-ARDS trial, MultiStem cells are infused in subjects with severe ARDS, he explains. […] The key focus of MUST-ARDS is to assess the safety and tolerability for patients and to evaluate secondary outcomes, including longer-term safety and tolerability, effect on pulmonary function and mortality. […] So far, all subjects have completed their 28-day visit, and the initial data suggest that the safety and tolerability are good, Dr. Jacono says.

• #1 Advances in acute respiratory distress syndrome: focusing on heterogeneity, pathophysiology, and therapeutic strategies | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-025-02127-9

  Although stem cells have therapeutic effects, they also have several disadvantages and adverse effects. […] Several cell products derived from stem cells, especially from MSCs, have been explored for efficacy and safety in the context of ARDS treatment. […] These findings indicate that MSCs-EVs exert powerful effects during ARDS therapy. […] Targeted therapy is a treatment strategy in which specific molecules associated with a disease are targeted to regulate pathological and physiological processes and achieve therapeutic goals. […] Compared to traditional broad-spectrum methods, targeted therapy is more effective and has fewer side effects. […] Targeted immunotherapy has emerged as a promising approach for treating ARDS; however, several challenges must be overcome to maximize its therapeutic potential.

• #1 Pharmacological treatments in ARDS; a state-of-the-art update | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-166

  The renin-angiotensin system (RAS) plays an important role in the pathogenesis of ARDS, with angiotensin converting enzyme 1 (ACE1) directing a RAS signal to the angiotensin 1 receptor (AT1R), mediating alveolar vasoconstriction, permeability and fibrosis. […] Collectively, these data provide encouragement for future clinical trials in this area. […] Regenerative medicine is an emerging field, using stem cells or growth factors to aid the repair of damaged tissue and organs. […] Clinical trials are awaited in this promising area. […] Despite many interventions being studied, to date there has been little success in developing effective pharmacological therapies for the management of ARDS. […] However, given the high associated morbidity and mortality, pressure remains to continue efforts to improve outcomes. […] Increasing numbers of pharmacological therapies are being investigated, and with encouraging pre-clinical and early clinical results, it is expected that over the coming years some will develop into useful agents for the prevention and treatment of ARDS.

• #2 Acute respiratory distress syndrome (ARDS) – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/374

  Acute respiratory distress syndrome (ARDS) typically presents with dyspnoea and hypoxaemia, which progress to acute respiratory failure. […] Low tidal volume, plateau-pressure-limited mechanical ventilation is the primary treatment that has been shown to reduce mortality. In severe ARDS, neuromuscular blockade, prone positioning, and extracorporeal membrane oxygenation (ECMO) may improve clinical outcomes. […] Complications include pneumothorax, ventilator-associated pneumonia, multiple organ failure, and pulmonary fibrosis with prolonged respiratory failure.

• #2 Acute Respiratory Distress Syndrome (ARDS) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/ards

  All ARDS patients must be given supplemental oxygen therapy and most will be placed on a mechanical ventilator to help them breathe. […] Though there is no cure for ARDS, its not uniformly fatal. With treatment, an estimated 60% to 75% of those who have ARDS will survive the disease. […] Treatment for ARDS typically aims to increase blood oxygen levels, provide breathing support, and treat the underlying cause of the disease. […] Most ARDS patients are placed on a mechanical ventilator, usually in the intensive care unit of a hospital. A ventilator takes over a persons breathing when they are unable to breathe on their own. […] Often patients are given diuretics to help clear away excess fluid buildup in the lungs, and pain medication to relieve discomfort. […] In addition to increasing blood oxygen levels, doctors must treat the underlying medical condition that led to ARDS.

• #2 ARDS Treatment and Recovery | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/ards/ards-treatment-and-recovery

  ARDS is a serious condition that can be frightening for patients and their loved ones. […] There is no cure for ARDS at this time. Treatment focuses on supporting the patient while the lungs heal. The goal of supportive care is getting enough oxygen into the blood and delivered to your body to prevent damage and removing the injury that caused ARDS to develop. […] All patients with ARDS will require extra oxygen. […] A ventilator is a machine used to open airspaces that have shut down and help with the work of breathing. […] When oxygen and ventilator therapies are at high levels and blood oxygen is still low, ARDS patients are sometimes turned over on their stomach to get more oxygen into the blood. […] To relieve shortness of breath and prevent agitation, the ARDS patient usually needs sedation.

• #2 Acute Respiratory Distress Syndrome (ARDS) Treatment & Management: Approach Considerations, Pharmacotherapy, Fluid Management

  https://emedicine.medscape.com/article/165139-treatment

  Although no specific therapy exists for ARDS, treatment of the underlying condition is essential, along with supportive care, noninvasive ventilation or mechanical ventilation using low tidal volumes, and conservative fluid management. […] Thus far, the only treatment found to improve survival in ARDS is a mechanical ventilation strategy using low tidal volumes (6 mL/kg based upon ideal body weight). […] Because infection is often the underlying cause of ARDS, early administration of appropriate antimicrobial therapy broad enough to cover suspected pathogens is essential, along with careful assessment of the patient to determine potential infection sources. […] In some instances, removal of intravascular lines, drainage of infected fluid collections, or surgical debridement or resection of an infected site (eg, the ischemic bowel) may be necessary because sepsis-associated ARDS does not resolve without such management.

• #2 Acute Respiratory Distress Syndrome (ARDS) Treatment & Management: Approach Considerations, Pharmacotherapy, Fluid Management

  https://emedicine.medscape.com/article/165139-treatment

  The main concerns are missing a potentially treatable underlying cause or complication of ARDS. […] In these critically ill patients, pay careful attention to early recognition of potential complications in the intensive care unit (ICU), including pneumothorax, IV line infections, skin breakdown, inadequate nutrition, arterial occlusion at the site of intra-arterial monitoring devices, DVT and pulmonary embolism (PE), retroperitoneal hemorrhage, gastrointestinal (GI) hemorrhage, erroneous placement of lines and tubes, and the development of muscle weakness. […] In addition, preventing complications associated with prolonged mechanical ventilation and ICU stay can include deep venous thrombosis (DVT) prophylaxis, stress ulcer prophylaxis, early mobilization, minimizing sedation, turning and skin care, and strategies to prevent ventilator-induced pneumonia, such as elevation of the head of the bed and use of a subglottic suction device.

• #2 ARDS – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ards/diagnosis-treatment/drc-20355581

  The first goal in treating ARDS is to improve the levels of oxygen in your blood. Without oxygen, your organs can’t work properly. […] To get more oxygen into your bloodstream, your healthcare professional likely will use: […] For milder symptoms or as a short-term treatment, oxygen may be delivered through a mask that fits tightly over your nose and mouth. […] Most people with ARDS need the help of a machine to breathe. A mechanical ventilator pushes air into your lungs and forces some of the fluid out of the air sacs. […] ECMO may be an option for severe ARDS when other treatment options, such as mechanical ventilation, don’t work. ECMO takes over for the heart, lungs or both for a limited time while the lungs rest and heal. This treatment can help when the body can’t provide the tissues with enough oxygen.

• #2 Acute respiratory distress syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Acute_respiratory_distress_syndrome

  Acute respiratory distress syndrome (ARDS) is usually treated with mechanical ventilation in the intensive care unit (ICU). […] The primary treatment involves mechanical ventilation together with treatments directed at the underlying cause. […] Ventilation strategies include using low volumes and low pressures. […] If oxygenation remains insufficient, lung recruitment maneuvers and neuromuscular blockers may be used. […] If these are insufficient, extracorporeal membrane oxygenation (ECMO) may be an option. […] Positive end-expiratory pressure (PEEP) is used in mechanically ventilated people with ARDS to improve oxygenation. […] The role of non-invasive ventilation is limited to the very early period of the disease or to prevent worsening respiratory distress in individuals with atypical pneumonias, lung bruising, or major surgery patients, who are at risk of developing ARDS.

• #2 Acute Respiratory Distress Syndrome: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0615/p730.html

  Starting with low tidal volumes of 6 mL per kg of predicted body weight is superior to starting with traditional volumes of 10 to 15 mL per kg. […] Higher PEEP values (12 cm H2O or higher) are associated with decreased mortality when compared with values of 5 to 12 cm H2O and should be used in patients with moderate or severe ARDS. […] Prone positioning requires moving a patient from the traditional supine position while maintaining the integrity of the patient-ventilator circuit and all venous, arterial, urinary, and other access lines. […] Inhaled nitric oxide is a pulmonary arterial vasodilator that may improve perfusion in ventilated areas and moderate the harmful inflammatory response that occurs in ARDS. […] Patients with ARDS should receive low-molecular-weight heparin, low-dose unfractionated heparin, or fondaparinux (Arixtra) to prevent venous thromboembolism, unless these agents are contraindicated. […] The role of corticosteroids is controversial. […] A randomized controlled trial found that intravenous pantoprazole (Protonix), 40 mg per day, decreased clinically important gastrointestinal bleeding compared with placebo.

• #2 Acute Respiratory Distress Syndrome: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0215/p352.html

  Acute respiratory distress syndrome often has to be differentiated from congestive heart failure, which usually has signs of fluid overload, and from pneumonia. Treatment of acute respiratory distress syndrome is supportive and includes mechanical ventilation, prophylaxis for stress ulcers and venous thromboembolism, nutritional support, and treatment of the underlying injury. […] Most patients with ARDS need sedation, intubation, and ventilation while the underlying injury is treated. Any ventilator mode may be used, according to the Surviving Sepsis Clinical Practice Guideline and the National Heart, Lung, and Blood Institute’s ARDS Network (ARDSNet). […] Evidence has shown that starting with low tidal volumes of 6 mL per kg is superior to starting with traditional tidal volumes of 10 to 15 mL per kg.

• #2 Managing Acute Respiratory Distress Syndromelogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na56980/2024/01/16/managing-acute-respiratory-distress-syndrome

  Higher levels of positive end-expiratory pressure (PEEP) are recommended for patients with moderate-to-severe ARDS. […] Strong recommendations for both low tidal volume ventilation and prone positioning for moderate-to-severe ARDS remain from the 2017 guideline. […] This guideline addresses use of steroids and neuromuscular blockade, both of which were omitted in the 2017 guideline. Administration of steroids should be considered in all patients with attention to the cause of ARDS and concomitant conditions (e.g., sepsis) to determine dose and duration. More cautious use of NMB makes sense, although it can be helpful in patients with severe ARDS and ventilator dyssynchrony. Venovenous ECMO remains resource-intense and should be considered only after optimization of mechanical ventilation, prone positioning, and neuromuscular blockade administration.

• #2 Management of severe acute respiratory distress syndrome: a primer | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-023-04572-w

  While APRV may increase mean airway pressures there is less control over tidal volume and minute ventilation. […] Despite its use in ARDS, high quality evidence favoring APRV is lacking, and the available studies reported mixed results. […] High frequency oscillatory ventilation (HFOV) is a mode of IMV that employs a constant airway pressure with oscillations at extreme respiratory frequencies (e.g., 5-15 Hz or 300-900 breaths per minute), delivering tidal volumes well below that of anatomical dead space. […] While HFOV was previously considered a rescue mode of ventilation for severe ARDS, its use has fallen out of favor. […] Prone ventilation improves oxygenation and ventilatory mechanics in many patients with severe ARDS. […] The PROSEVA trial is the most notable study of early proning in patients with moderate-to-severe ARDS (P/F150, FIO260%).

• #2 Formal guidelines: management of acute respiratory distress syndrome | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0540-9

  Fifteen recommendations and a therapeutic algorithm regarding the management of acute respiratory distress syndrome (ARDS) at the early phase in adults are proposed. […] Four recommendations (low tidal volume, plateau pressure limitation, no oscillatory ventilation, and prone position) had a high level of proof (GRADE 1+ or 1); four (high positive end-expiratory pressure [PEEP] in moderate and severe ARDS, muscle relaxants, recruitment maneuvers, and venovenous extracorporeal membrane oxygenation [ECMO]) a low level of proof (GRADE 2+ or 2); seven (surveillance, tidal volume for non ARDS mechanically ventilated patients, tidal volume limitation in the presence of low plateau pressure, PEEP5 cmH2O, high PEEP in the absence of deleterious effect, pressure mode allowing spontaneous ventilation after the acute phase, and nitric oxide) corresponded to a level of proof that did not allow use of the GRADE classification and were expert opinions. […] The recommendations and the therapeutic algorithm were approved by the experts with strong agreement.

• #2 Managing Acute Respiratory Distress Syndromelogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na56980/2024/01/16/managing-acute-respiratory-distress-syndrome

  This update of a 2017 clinical practice guideline addresses use of steroids and neuromuscular blockade for ARDS patients. […] Administration of steroids is recommended, although without specific guidance on choice of steroid, dose, timing, or duration. The document suggests following steroid recommendations for specific causes of ARDS (e.g., COVID-19, community-acquired pneumonia). […] Neuromuscular blockade (NMB) is recommended in early treatment of patients with severe ARDS (partial pressure of oxygen [PaO2]:fraction of inspired oxygen [FiO2] <100) and courses should be limited to 48 hours or shorter. [...] Venovenous extracorporeal membrane oxygenation (ECMO) now is recommended for select patients with severe ARDS (PaO2:FiO2 <80 or pH <7.25 with PaCO2 ≥60 mm Hg), although with low certainty of evidence.

• #2 ARDS – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ards/diagnosis-treatment/drc-20355581

  For some people with ARDS, positioning on the stomach what’s known as a prone position during mechanical ventilation may make more oxygen available to the lungs. […] Carefully managing the amount of IV fluids given to people with ARDS is very important. Giving too much fluid can make more fluid build up in the lungs. Giving too little fluid can strain the heart and other organs, leading to shock. […] People with ARDS usually get medicine to: […] When other treatments don’t help, lung transplant may be an option for some carefully chosen people who have ARDS. Usually, these are people who were healthy before they developed severe ARDS. Because lung transplant is such a hard process, it should be done at a center that has highly skilled, experienced surgeons and transplant teams.

• #2 Acute Respiratory Distress Syndrome (ARDS) Treatment & Management: Approach Considerations, Pharmacotherapy, Fluid Management

  https://emedicine.medscape.com/article/165139-treatment

  No drug has consistently proved beneficial in the prevention or management of acute respiratory distress syndrome (ARDS). […] Early administration of corticosteroids to septic patients does not prevent the development of ARDS. […] A study by Martin-Loeches et al concluded that the early use of corticosteroids was also ineffective in patients with the pandemic H1N1 influenza A infection, resulting in an increased risk of superinfections. […] More recently, a multi-center randomized controlled trial conducted at 17 ICUs in Spain showed more promising results with corticosteroids. […] The dexamethasone group was administered intravenous (IV) administration of 20 mg once daily five days, which was reduced to 10 mg once daily another 5 days. […] The patients in the dexamethasone group had increased ventilator-free days with a group difference of 4-8 days.

• #2 Formal guidelines: management of acute respiratory distress syndrome | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0540-9

  Once tidal volume is set to around 6 mL/kg PBW, plateau pressure should be monitored continuously and should not exceed 30 cmH2O to reduce mortality. […] The experts suggest that tidal volume should not be increased when the plateau pressure is well below 30 cmH2O, except in cases of marked, persistent hypercapnia despite reduction of instrumental dead space and increase of respiratory rate. […] PEEP is an essential component of the management of ARDS and the experts suggest using a value above 5 cmH2O in all patients presenting with ARDS. […] High PEEP should probably be used in patients with moderate or severe ARDS, but not in patients with mild ARDS. […] A neuromuscular blocking agent should probably be considered in ARDS patients with a PaO2/FiO2 ratio150 mmHg to reduce mortality. […] The neuromuscular blocking agent should be administered by continuous infusion early (within 48 h after the start of ARDS), for no more than 48 h, with at least daily evaluation.

• #2 Acute Respiratory Distress Syndrome (ARDS) Medication: Corticosteroids

  https://emedicine.medscape.com/article/165139-medication

  Because of apparent benefit in small trials, it was thought that there might be a role for high-dose corticosteroid therapy in patients with late (fibroproliferative phase) ARDS. However, an ARDS Study Network trial of methylprednisolone for patients with ARDS persisting for at least 7 days demonstrated no benefit in terms of 60-day mortality. Patients treated later in the course of ARDS, 14 days after onset, had worsened mortality with corticosteroid therapy. […] Although no survival advantage was shown in patients treated with methylprednisolone, short-term clinical benefits included improved oxygenation and increased ventilator-free and shock-free days. Patients treated with corticosteroids were more likely to experience neuromuscular weakness, but the rate of infectious complications was not increased.

• #2 Acute Respiratory Distress Syndrome (ARDS) Medication: Corticosteroids

  https://emedicine.medscape.com/article/165139-medication

  More recently, a multi-center randomized controlled trial conducted at 17 ICUs in Spain showed more promising results. In the study, 277 patients with moderate-to-severe ARDS were randomly assigned to receive either dexamethasone (139 patients) or placebo (138 patients). The dexamethasone group was administered intravenous (IV) administration of 20 mg once daily five days, which was reduced to 10 mg once daily another 5 days. Both groups received lung-protective mechanical ventilation. The patients in the dexamethasone group had increased ventilator-free days with a group difference of 4-8 days. At 60 days, the placebo group had significantly higher mortality compared to the dexamethasone group (36% vs 21%, respectively). […] Development of the late phase of ARDS may represent continued uncontrolled inflammation, and corticosteroids may be considered a form of rescue therapy that may improve oxygenation and hemodynamics but does not change mortality (except that corticosteroids increase mortality in patients who have had ARDS for 14 d). […] High-dose methylprednisolone has been used in trials of patients with ARDS who have persistent pulmonary infiltrates, fever, and high oxygen requirement despite resolution of pulmonary or extrapulmonary infection.

• #2 Acute Respiratory Distress Syndrome (ARDS)

  https://my.clevelandclinic.org/health/diseases/15283-acute-respiratory-distress-syndrome-ards

  Acute respiratory distress syndrome (ARDS) is a lung injury that happens when fluids build up in small air sacs (alveoli) in your lungs. ARDS prevents your lungs from filling up with air and causes dangerously low oxygen levels in your blood (hypoxia). […] Treatment for ARDS involves increasing oxygen levels in your blood to prevent organ failure. People with ARDS need a mechanical ventilator and/or oxygen therapy to improve blood oxygen levels. They also need help to open up the airways that have closed due to damage. […] Your healthcare provider may take steps to minimize complications from ARDS. These include: Sedation to manage pain and sedatives help you relax. Placing you in a prone position (on your stomach), instead of on your back. Breathing tests to determine when its safe to remove the tube and ventilator. Blood thinners to prevent clots. Diuretics to remove extra fluid from your body. Medications to minimize fluid buildup in your lungs. Antibiotics to prevent or treat infection. Active mobility and physical therapy to prevent muscle weakness. Pulmonary rehabilitation to help strengthen your lungs and increase lung capacity.

• #2 Formal guidelines: management of acute respiratory distress syndrome | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0540-9

  Prone positioning should be used in ARDS patients with PaO2/FIO2 ratio150 mmHg to reduce mortality. […] Sessions of at least 16 consecutive hours should be performed. […] Venovenous extracorporeal membrane oxygenation (ECMO) should probably be considered in cases of severe ARDS with PaO2/FiO2<80 mmHg and/or when mechanical ventilation becomes dangerous because of the increase in plateau pressure and despite optimization of ARDS management including high PEEP, neuromuscular blocking agents, and prone positioning. [...] The decision to use ECMO should be evaluated early by means of contact with an expert center. [...] The experts suggest that inhaled nitric oxide can be used in cases of ARDS with deep hypoxemia despite the implementation of a protective ventilation strategy and prone positioning, and before envisaging use of venovenous ECMO.

• #2 Acute Respiratory Distress Syndrome: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0215/p352.html

  Pharmacologic options for the treatment of ARDS are limited. Although surfactant therapy may be helpful in children with ARDS, a Cochrane review did not find it to be beneficial in adults. […] The use of corticosteroids is controversial. Randomized controlled trials and cohort studies tend to support early use of corticosteroids (with dosages of methylprednisolone [Solu-Medrol] ranging from 1 to 120 mg per kg per day) for decreasing the number of days on a ventilator; however, no consistent mortality benefit has been shown with this therapy. […] Patients with ARDS should also receive low-molecular-weight heparin (40 mg of enoxaparin [Lovenox] or 5,000 units of dalteparin [Fragmin] subcutaneously per day) or low-dose, unfractionated heparin (5,000 units subcutaneously twice daily) to prevent venous thromboembolism, unless contraindicated. […] Treatment of ARDS is supportive, including mechanical ventilation, prevention of stress ulcers and venous thromboembolism, and nutritional support.

• #2 Emerging pharmacological therapies for ARDS: COVID-19 and beyond

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7352097/

  Nebulized heparin reduced the need for mechanical ventilation in a small phase 2 study of 50 critically ill patients. […] Streptokinase binds plasminogen to form plasmin. […] Nebulized streptokinase improved oxygenation and lung compliance in a phase 3 trial in 60 patients with late phase severe ARDS, suggesting promise as a rescue therapy for ARDS patients. […] There is a host of potential drug therapies demonstrating promise for ARDS, from drugs that modulate the immune response, specific inflammatory pathway blockers, epithelial and channel function modulators, endothelial and vascular dysfunction therapies, anticoagulant drugs, and therapies that aid resolution of ARDS. […] It is hoped that the substantial number of studies globally investigating potential therapies for severe COVID-19 patients will help the identification of effective therapies for ARDS.

• #2 Acute Respiratory Distress Syndrome (ARDS): Causes, Symptoms & Treatment

  https://www.emedicinehealth.com/acute_respiratory_distress_syndrome/article_em.htm

  Anti-inflammatory drugs, such as corticosteroids, reduce inflammation in the lungs in the late phase of ARDS or sometimes if the person is in septic shock […] Diuretics to eliminate fluid from the lungs […] Drugs to counteract low blood pressure that may be caused by shock […] Anti-anxiety drugs to relieve anxiety […] Inhaled drugs administered by respiratory therapists to open up the airways (bronchodilators).

• #2

  https://www.jci.org/articles/view/60331

  The primary beneficial mechanism can be explained by a favorable effect on Starling forces: lower vascular pressure reduces transvascular fluid filtration, particularly in the presence of increased lung vascular permeability. […] There has been considerable interest in the possibility that anticoagulant therapy may be effective in ALI and ARDS because of the close link between procoagulant and proinflammatory pathways. […] Cell-based therapy with allogeneic human MSCs has emerged as a promising approach to therapy for ALI and ARDS.

• #2 Acute Respiratory Distress Syndrome – Treatment | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/ards/treatment

  Antibiotics treat or prevent infections. […] Blood thinners stop blood clots from forming or growing larger. […] Muscle relaxants help prevent coughing or gagging while on a ventilator or reduce the amount of oxygen your body needs. […] Sedatives help relieve anxiety, make it easier to breathe on a ventilator, or lower your body’s oxygen needs. […] Your doctor may recommend other treatments, including the following: A feeding tube can ensure you get enough of the right nutrients while you are on a ventilator. […] Blood transfusions treat low hemoglobin levels. […] Extracorporeal membrane oxygenation (ECMO) or a similar device helps when ventilation alone cannot deliver enough oxygen or while a patient waits for a lung transplant. […] Fluid management through an intravenous (IV) line helps restore fluid levels if needed. […] Lying facedown helps get more oxygen to your lungs. […] Physical therapy maintains muscle strength and prevent sores from forming.

• #2 Acute respiratory distress syndrome Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/acute-respiratory-distress-syndrome

  ARDS often needs to be treated in an intensive care unit (ICU). […] The goal of treatment is to provide breathing support and treat the cause of ARDS. This may involve medicines to treat infections, reduce inflammation, and remove fluid from the lungs. […] A ventilator is used to deliver high doses of oxygen and positive pressure to the damaged lungs. People often need to be deeply sedated with medicines. During treatment, your health care providers make every effort to protect your lungs from further damage. Certain ways of using the ventilator can protect your lungs better and improve chances of recovery. Treatment is mainly supportive until the lungs recover. […] Sometimes, a treatment called extracorporeal membrane oxygenation (ECMO) is done. During ECMO, blood is filtered through a machine to provide oxygen and remove carbon dioxide.

• #2 Acute Respiratory Distress Syndrome (ARDS) Treatment & Management: Approach Considerations, Pharmacotherapy, Fluid Management

  https://emedicine.medscape.com/article/165139-treatment

  In patients requiring prolonged mechanical ventilation, tracheostomy allows the establishment of a more stable airway, which may allow for mobilization of the patient and, in some instances, may facilitate weaning from mechanical ventilation. […] A large multicenter trial in the 1970s demonstrated that extracorporeal membrane oxygenation (ECMO) did not improve the mortality rate in ARDS patients. […] However, during the H1N1 flu epidemic in 2009, ECMO appeared to improve survival in patients with H1N1-associated ARDS who could not be oxygenated with conventional mechanical ventilation. […] Nutritional support after 48-72 hours of mechanical ventilation usually is recommended. […] A low-carbohydrate high-fat enteral formula including anti-inflammatory and vasodilating components (eicosapentaenoic acid and linoleic acid) along with antioxidants has been demonstrated in some studies to improve outcome in ARDS.

• #2 Acute Respiratory Distress Syndrome (ARDS) Treatment & Management: Approach Considerations, Pharmacotherapy, Fluid Management

  https://emedicine.medscape.com/article/165139-treatment

  Patients with ARDS are on bed rest. […] Frequent position changes should be started immediately, as should passive and, if possible, active range-of-motion activities of all muscle groups. […] Once the acute phase of ARDS resolves, patients may require a prolonged period to be weaned from mechanical ventilation and to regain muscle strength lost after prolonged inactivity. […] Although multiple risk factors for ARDS are known, no successful preventive measures have been identified. […] In patients without ARDS on mechanical ventilation, the use of high tidal volumes appears to be a risk factor for the development of ARDS, and, therefore, the use of lower tidal volumes in all patients on mechanical ventilation may prevent some cases on ARDS. […] Treatment of patients with ARDS requires special expertise with mechanical ventilation and management of critical illness.

• #2 Pharmacological treatments in ARDS; a state-of-the-art update | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-166

  The renin-angiotensin system (RAS) plays an important role in the pathogenesis of ARDS, with angiotensin converting enzyme 1 (ACE1) directing a RAS signal to the angiotensin 1 receptor (AT1R), mediating alveolar vasoconstriction, permeability and fibrosis. […] Collectively, these data provide encouragement for future clinical trials in this area. […] Regenerative medicine is an emerging field, using stem cells or growth factors to aid the repair of damaged tissue and organs. […] Clinical trials are awaited in this promising area. […] Despite many interventions being studied, to date there has been little success in developing effective pharmacological therapies for the management of ARDS. […] However, given the high associated morbidity and mortality, pressure remains to continue efforts to improve outcomes. […] Increasing numbers of pharmacological therapies are being investigated, and with encouraging pre-clinical and early clinical results, it is expected that over the coming years some will develop into useful agents for the prevention and treatment of ARDS.

• #2 Advances in acute respiratory distress syndrome: focusing on heterogeneity, pathophysiology, and therapeutic strategies | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-025-02127-9

  The etiology, physiology and microbiology of ARDS are highly heterogeneous, so personalized medicine approaches for patients with different phenotypes might be a goal of future treatment. […] However, as our understanding of ARDS deepens, we should also be aware of some limitations in the definition of ARDS. […] After over 70 years of struggling to treat ARDS, supportive care remains the main treatment approach, and few drugs have been proven effective for all patients. […] In recent years, cell therapy has shown great promise in preclinical ARDS research. […] The therapeutic effects of these cells mainly occur via two different mechanisms: direct cell interactions and the paracrine release of cellular components such as extracellular vesicles (EVs). […] Several animal studies have demonstrated that MSC therapy is a promising novel intervention for ARDS.

• #2 Clinical Trial for Acute Respiratory Distress Syndrome – MultiStem Therapy Tested as ARDS Treatment | University Hospitals

  https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2019/06/clinical-trial-seeks-potential-ards-treatment

  For the more than 200,000 patients diagnosed every year with Acute Respiratory Distress Syndrome (ARDS), there are few treatment options. […] To that end, UH is participating in a Phase I/II clinical trial called MultiStem Therapy in Acute Respiratory Distress Syndrome (MUST-ARDS). […] MultiStem is a bone-marrow cell therapy product derived from multi-potent adult progenitor cells, Dr. Jacono explains. […] In the MUST-ARDS trial, MultiStem cells are infused in subjects with severe ARDS, he explains. […] The key focus of MUST-ARDS is to assess the safety and tolerability for patients and to evaluate secondary outcomes, including longer-term safety and tolerability, effect on pulmonary function and mortality. […] So far, all subjects have completed their 28-day visit, and the initial data suggest that the safety and tolerability are good, Dr. Jacono says.

• #2 Clinical Trial for Acute Respiratory Distress Syndrome – MultiStem Therapy Tested as ARDS Treatment | University Hospitals

  https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2019/06/clinical-trial-seeks-potential-ards-treatment

  If the preliminary results hold up, if MultiStem looks well tolerated with signs it is effective, the plan is to go ahead with a larger trial to determine whether we should offer MultiStem more broadly to patients with severe ARDS, he says. […] ARDS is associated with significant morbidity and mortality, and there are currently no effective therapies to help patients with the disease.

• #2 ARDS Treatment Information | Medication & Therapy

  https://www.nationaljewish.org/conditions/ards/treatment

  How is acute respiratory distress syndrome (ARDS) treated? […] Treating acute respiratory distress syndrome includes addressing any lung damage or other injury, and helping the patient breathe consistently while the lungs heal and the body fights the infection. Treatment can take weeks to months depending on the severity of the infection. […] Treatments for ARDS can include: […] Supplemental oxygen ensures the body is getting enough oxygen in the lungs and the blood […] Mechanical ventilator supports the work it takes to breath with ARDS […] Sedation intravenous medications are used to induce sedation or coma, if needed, to help the patient breath […] Other medications antibiotics are used to treat infection, heparin is used to prevent blood clots, Lasix is used to remove extra fluid and other medications can be used to support a patients blood pressure

• #2 Acute Respiratory Distress Syndrome (ARDS)

  https://my.clevelandclinic.org/health/diseases/15283-acute-respiratory-distress-syndrome-ards

  Survival rates for ARDS are around 55% to 70% when treatment is prompt. If treatment is delayed or other organs begin to fail, survival rates are lower. […] ARDS can be life-threatening and scary. But improved care and ventilator treatments including having people lay face down (prone) to improve oxygen flow are helping more people survive and reduce ARDS complications. The outlook is typically better in people younger than 65 and when trauma or a blood transfusion causes ARDS. […] Yes, your lungs can recover from ARDS. The exact amount of time varies depending on how much lung damage you have. Most people regain their lung function within two years, although several factors go into that estimate.

• #2 Acute Respiratory Distress Syndrome: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0615/p730.html

  Acute respiratory distress syndrome (ARDS) is noncardiogenic pulmonary edema that manifests as rapidly progressive dyspnea, tachypnea, and hypoxemia. […] Treatment of ARDS is supportive and includes mechanical ventilation, prophylaxis for stress ulcers and venous thromboembolism, nutritional support, and treatment of the underlying injury. Low tidal volume and high positive end-expiratory pressure improve outcomes. Prone positioning is recommended for some moderate and all severe cases. […] Treatment of ARDS is generally supportive, consisting of mechanical ventilation, prevention of stress ulcers and venous thromboembolism, and nutritional support while addressing the underlying etiology. […] Although mild cases of ARDS may respond to noninvasive ventilation, most patients require sedation, intubation, and ventilation while the underlying injury is treated.

• #2 Acute respiratory distress syndrome: potential of therapeutic interventions effective in treating progression from COVID-19 to treat progression from other illnesses—a systematic review | BMJ Open Respiratory Research

  https://bmjopenrespres.bmj.com/content/10/1/e001525

  A shift towards personalised treatments for both CARDS and ARDS, as reflected through the increasing use of biologics, is also evident. […] As ongoing CARDS clinical trials progress, their findings are likely to have important implications that alter the management of ARDS in patients that develop the condition from illnesses other than COVID-19 in the future. […] The systematic review evaluates the potential of novel therapeutic interventions developed for COVID-19 ARDS in the treatment of ARDS when developed from other illnesses. It is shown that complement system modifiers, cell-based therapies and biologics hold clear potential. […] The present systematic review has identified a range of therapies assessed for their effectiveness in both ARDS and CARDS, and it has highlighted several treatments that at the time of the study in March 2022 showed therapeutic efficacy in CARDS with potential in the treatment of ARDS.

• #3 Formal guidelines: management of acute respiratory distress syndrome | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0540-9

  Once tidal volume is set to around 6 mL/kg PBW, plateau pressure should be monitored continuously and should not exceed 30 cmH2O to reduce mortality. […] The experts suggest that tidal volume should not be increased when the plateau pressure is well below 30 cmH2O, except in cases of marked, persistent hypercapnia despite reduction of instrumental dead space and increase of respiratory rate. […] PEEP is an essential component of the management of ARDS and the experts suggest using a value above 5 cmH2O in all patients presenting with ARDS. […] High PEEP should probably be used in patients with moderate or severe ARDS, but not in patients with mild ARDS. […] A neuromuscular blocking agent should probably be considered in ARDS patients with a PaO2/FiO2 ratio150 mmHg to reduce mortality. […] The neuromuscular blocking agent should be administered by continuous infusion early (within 48 h after the start of ARDS), for no more than 48 h, with at least daily evaluation.

• #4 Acute Respiratory Distress Syndrome: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0615/p730.html

  Starting with low tidal volumes of 6 mL per kg of predicted body weight is superior to starting with traditional volumes of 10 to 15 mL per kg. […] Higher PEEP values (12 cm H2O or higher) are associated with decreased mortality when compared with values of 5 to 12 cm H2O and should be used in patients with moderate or severe ARDS. […] Prone positioning requires moving a patient from the traditional supine position while maintaining the integrity of the patient-ventilator circuit and all venous, arterial, urinary, and other access lines. […] Inhaled nitric oxide is a pulmonary arterial vasodilator that may improve perfusion in ventilated areas and moderate the harmful inflammatory response that occurs in ARDS. […] Patients with ARDS should receive low-molecular-weight heparin, low-dose unfractionated heparin, or fondaparinux (Arixtra) to prevent venous thromboembolism, unless these agents are contraindicated. […] The role of corticosteroids is controversial. […] A randomized controlled trial found that intravenous pantoprazole (Protonix), 40 mg per day, decreased clinically important gastrointestinal bleeding compared with placebo.

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