Materiały źródłowe

• #1 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  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. […] Current initiatives have broadened the scope of lung injury research to include primary prevention of ARDS and prevention of morbidity among ARDS survivors. […] To facilitate these efforts, the National Institutes of Health has formed the Prevention and Early Treatment of Acute Lung Injury (PETAL) Network to conduct multicenter clinical trials aimed at further decreasing the disease burden of ARDS. […] Clinical trials targeting the prevention of ARDS face several key design challenges.

• #2 Antiplatelet Therapy for Acute Respiratory Distress Syndrome

  https://www.mdpi.com/2227-9059/8/7/230

  Acute respiratory distress syndrome (ARDS) is a common and devastating syndrome that contributes to serious morbidities and mortality in critically ill patients. […] The only effective management to date to improve the survival rate of this syndrome is a protective lung strategy, with lower tidal volume ventilation. […] Therefore, the discovery of medications to prevent the development of ARDS is crucial. […] Overall, dysregulated inflammation, the inappropriate accumulation and activity of leukocytes and platelets, uncontrolled activation of coagulation pathways, and altered permeability of alveolar endothelial and epithelial barriers are pathophysiological hallmarks of ARDS. […] The possible mechanisms by which platelets contribute to ARDS include the activation of endothelial cells by the release of pro-inflammatory mediators and adherence of platelets to lung capillary endothelial cells leading to the activation of attached leukocytes.

• #3

  https://journals.lww.com/co-criticalcare/Fulltext/2015/02000/Prevention_of_acute_respiratory_distress_syndrome.13.aspx?WT.mc_id=HPxADx20100319xMP&generateEpub=Article%7Cco-criticalcare:2015:02000:00013%7C10.1097/mcc.0000000000000174%7C

  The paucity of effective therapeutic interventions in patients with the acute respiratory distress syndrome (ARDS) combined with overwhelming evidence on the importance of timely implementation of effective therapies to critically ill patients has resulted in a recent shift in ARDS research. […] Increasingly, efforts are being directed toward early identification of patients at risk with a goal of prevention and early treatment, prior to development of the fully established syndrome. […] The primary thematic categories presented in the present review article include early identification of patients at risk of developing ARDS, optimization of care delivery and its impact on the incidence of ARDS, pharmacological prevention of ARDS, prevention of postoperative ARDS, and challenges and opportunities with ARDS prevention studies.

• #4 Acute respiratory distress syndrome: prevention and early recognition | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-3-11

  Acute respiratory distress syndrome (ARDS) is common in critically ill patients admitted to intensive care units (ICU). […] Research focusing on preventing ARDS and identifying patients at risk of developing ARDS is necessary to develop strategies to alter the clinical course and progression of the disease. […] Identifying patients at risk and implementing prevention strategies in this group are key factors in preventing ARDS. […] The first obstacle to preventing ARDS is identifying patients at risk of developing ARDS. […] Implementing preventive measures requires an algorithm for early detection. […] The combination of early clinical recognition and predictive scores could help in the detection of patients at-risk and in the early treatment or implementation of preventive strategies.

• #5 Acute respiratory distress syndrome: prevention and early recognition | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-3-11

  Acute respiratory distress syndrome (ARDS) is common in critically ill patients admitted to intensive care units (ICU). […] Research focusing on preventing ARDS and identifying patients at risk of developing ARDS is necessary to develop strategies to alter the clinical course and progression of the disease. […] Identifying patients at risk and implementing prevention strategies in this group are key factors in preventing ARDS. […] The first obstacle to preventing ARDS is identifying patients at risk of developing ARDS. […] Implementing preventive measures requires an algorithm for early detection. […] The combination of early clinical recognition and predictive scores could help in the detection of patients at-risk and in the early treatment or implementation of preventive strategies.

• #6 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  In a single-center study, implementation of protocol-guided tidal volume and transfusion management was associated with a significantly lower incidence of ARDS. […] The utility of adopting CLIP as a patient-level checklist may vary depending on an institution’s local practices, but the measures in CLIP should be viewed as the current best practice for ARDS prevention. […] Investigating new therapies targeting ARDS prevention necessitates reliable early identification of patients at risk for lung injury. […] A LIPS totaling 4 points has a sensitivity of 0.69, specificity of 0.78, positive predictive value of 0.18, and negative predictive value of 0.97. […] More recently, angiopoietin-2 used together with LIPS was shown to predict subsequent development of ARDS better than either alone.

• #7 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  In a single-center study, implementation of protocol-guided tidal volume and transfusion management was associated with a significantly lower incidence of ARDS. […] The utility of adopting CLIP as a patient-level checklist may vary depending on an institution’s local practices, but the measures in CLIP should be viewed as the current best practice for ARDS prevention. […] Investigating new therapies targeting ARDS prevention necessitates reliable early identification of patients at risk for lung injury. […] A LIPS totaling 4 points has a sensitivity of 0.69, specificity of 0.78, positive predictive value of 0.18, and negative predictive value of 0.97. […] More recently, angiopoietin-2 used together with LIPS was shown to predict subsequent development of ARDS better than either alone.

• #8 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  In a single-center study, implementation of protocol-guided tidal volume and transfusion management was associated with a significantly lower incidence of ARDS. […] The utility of adopting CLIP as a patient-level checklist may vary depending on an institution’s local practices, but the measures in CLIP should be viewed as the current best practice for ARDS prevention. […] Investigating new therapies targeting ARDS prevention necessitates reliable early identification of patients at risk for lung injury. […] A LIPS totaling 4 points has a sensitivity of 0.69, specificity of 0.78, positive predictive value of 0.18, and negative predictive value of 0.97. […] More recently, angiopoietin-2 used together with LIPS was shown to predict subsequent development of ARDS better than either alone.

• #9 Are there risk factors and preventative interventions for acute respiratory distress syndrome (ARDS) in COVID-19? | The Centre for Evidence-Based Medicine

  https://www.cebm.net/covid-19/are-there-risk-factors-and-preventative-interventions-for-acute-respiratory-distress-syndrome-ards-in-covid-19/

  Seventeen studies were included in this rapid review (117), with older age, diabetes, certain blood tests and African American ethnicity amongst the most evidenced risk factors for ARDS. […] In short, we found a lack of robust data regarding risk factors or prevention of COVID-19 ARDS and identified an urgent need for high quality research in this area. […] Given the potential severity of ARDS, being alert to which patients are at an increased risk of ARDS or being aware of interventions to reduce the likelihood of ARDS has the potential to be influential in clinical practice. […] This review focuses on COVID-19 specific knowledge and aims to determine if there are any known risk factors for ARDS in this infection and whether there are any interventions to prevent ARDS developing. […] There remains significant scope and need for studies to robustly determine risk factors and preventative interventions for ARDS in COVID-19.

• #10 Respiratory Distress Syndrome, Acute (ARDS) | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688506/all/Respiratory_Distress_Syndrome__Acute__ARDS_

  To date, there has been no effective strategy proven to prevent developing ARDS; however, measures can be taken to mitigate risk factors. […] Early lung protective ventilation and sepsis management have both been shown to improve clinical outcomes in ARDS.

• #11 Clinical Strategies to Prevent Acute Respiratory Distress Syndrome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/31060094/

  Acute respiratory distress syndrome (ARDS) remains an important clinical entity in the intensive care unit with a significant impact on morbidity and mortality. Effective therapeutic interventions are limited; thus current research focus has shifted from treatment to the prevention of this pulmonary syndrome. […] In recent decades, a decrease in the incidence of ARDS has been observed and this reduction is largely due to preventive strategies including safe lung ventilation practices, avoidance of iatrogenic exposures, and improvement in care of predisposing conditions such as sepsis and pneumonia. […] Early identification of at-risk patients, prompt treatment of predisposing conditions, and adoption of evidence-based best practice including restrictive transfusion strategies, conservative fluid management, avoidance of large tidal volume ventilation, and aspiration precaution practices are key preventive strategies with demonstrated benefits. […] There are currently no effective pharmacological preventive strategies for ARDS.

• #12 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  Early phase multicenter randomized trials of aspirin, inhaled corticosteroids, and aerosolized 2-agonists are ongoing. […] Several preclinical and epidemiologic studies have suggested a role for aspirin in preventing ARDS. […] Supporting translation of these findings, a single-center observational study of 161 at-risk patients found that prehospitalization antiplatelet therapy was independently associated with a decreased risk for ARDS. […] The primary outcome is the development of ARDS within 7 days of hospitalization. […] Inhalation of corticosteroids may prevent ARDS through inhibition of the proinjurious inflammatory response. […] A murine model of acid aspiration-induced lung injury found that clinically relevant concentrations of 2-agonists stimulate maximal cyclic adenosine monophosphate-dependent alveolar fluid clearance and decrease pulmonary edema. […] A number of other therapies have been proposed for the prevention of ARDS among at-risk patients and have been reviewed. […] Advances in multiple aspects of critical care delivery have contributed to a substantial decline in the incidence of ARDS over the past several years.

• #13 Acute respiratory distress syndrome: prevention and early recognition | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-3-11

  Beyond the etiology, certain modifiable external factors can accelerate the development of ARDS. […] Lung-protective mechanical ventilation strategies are the only supportive therapy that clearly improve survival in patients with ARDS. […] Thus, it may be beneficial to implement protective ventilation strategies from the start of mechanical ventilation, not only when ARDS appears. […] In our opinion, preventive strategies also should include protective ventilation with low tidal volume in patients at risk, and some studies support this approach. […] The use of prophylactic PEEP in patients without ARDS is controversial. […] The strategy of reduction the time of blood storage seems reasonable to prevent nonimmune TRALI. […] It seems that early detection of patients with sepsis who are at risk of developing ARDS is one way to achieve better results in the earliest phase.

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

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

  Although multiple risk factors for ARDS are known, no successful preventive measures have been identified. […] Careful fluid management in high-risk patients may be helpful. Because aspiration pneumonitis is a risk factor for ARDS, taking appropriate measures to prevent aspiration (eg, elevating the head of the bed and evaluating swallowing mechanics before feeding high-risk patients) may also prevent some ARDS cases. […] 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. […] In situations where the patient requires the use of paralyzing agents to allow certain modes of mechanical ventilation, take meticulous care to ensure that an adequate alarm system is in place to alert staff to mechanical ventilator disconnection or malfunction. In addition, adequate sedation is important in most patients on ventilators and is essential when paralytic agents are in use.

• #15 Clinical Practice Guideline of Acute Respiratory Distress Syndrome

  https://www.accjournal.org/journal/view.php?doi=10.4266/kjccm.2016.31.2.76

  There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). […] In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. […] We recommend low tidal volume ventilation can be applied to patients with acute respiratory distress syndrome (ARDS) to reduce mortality (Grade 1A). […] We suggest high positive end-expiratory pressure (PEEP) can be applied to patients with ARDS, who have PaO2/FIO2 200 mmHg to reduce mortality (Grade 2B). […] We recommend prone position can be applied to patients with moderate or above acute respiratory distress syndrome to reduce mortality if it is not contraindicated (Grade 1B). […] We suggest extracorporeal membrane oxygenation as a rescue therapy in patients with acute respiratory distress syndrome without improvement of hypoxia by lung protective ventilation strategy (Grade 2C).

• #16 Guideline-based management of acute respiratory failure and acute respiratory distress syndrome | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-023-00658-3

  Acute respiratory failure (ARF) is defined by acute and progressive hypoxemia caused by various cardiorespiratory or systemic diseases in previously healthy patients. Among ARF, acute respiratory distress syndrome (ARDS) is a serious condition with bilateral lung infiltration, which develops secondary to a variety of underlying conditions, diseases, or injuries. […] When administering fluid in patients with ARF, particularly ARDS, restrictive strategies need to be considered in patients without shock or multiple organ dysfunction. […] Low tidal volume ventilation is now weakly recommended for all patients with ARF and strongly recommended for patients with ARDS. […] Limiting plateau pressure and high-level PEEP are weakly recommended for moderate-to-severe ARDS. […] Prone position ventilation with prolonged hours is weakly to strongly recommended for moderate-to-severe ARDS.

• #17 Clinical Practice Guideline of Acute Respiratory Distress Syndrome

  https://www.accjournal.org/journal/view.php?doi=10.4266/kjccm.2016.31.2.76

  We recommend low tidal volume ventilation can be applied in patients who require mechanical ventilation for diseases other than acute respiratory distress syndrome (ARDS) (Grade 1B). To lower the incidence of pulmonary complications including ARDS in intraoperative patients, lung protective ventilation strategy may be applied during the operation (Grade 2B). […] We recommend light sedation should be conducted in critically ill patients who receive mechanical ventilation including acute respiratory distress syndrome (ARDS) (Grade 1B). […] We suggest early tracheostomy in patients who receive mechanical ventilation can be performed only in limited cases (Grade 2A).

• #18 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  The following review directly addresses these practical challenges for studies of ARDS prevention and discusses potential therapies for this novel indication, including those already under investigation in early stage trials. […] Significant advances in the care of critically ill patients have decreased the incidence of ARDS over the past 20 years. […] Among key contributing measures are lung-protective ventilation, timely resuscitation and antimicrobial administration, restrictive transfusion strategies, and ventilator care bundles. […] Timely resuscitation and antimicrobial administration for sepsis, a major risk factor for ARDS, also play important roles in ARDS prevention. […] Evolving transfusion practices have also contributed to the declining incidence of ARDS. […] Measures to prevent aspiration and nosocomial pneumonia also may have contributed to the declining incidence of ARDS.

• #19 Acute respiratory distress syndrome: prevention and early recognition | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-3-11

  Beyond the etiology, certain modifiable external factors can accelerate the development of ARDS. […] Lung-protective mechanical ventilation strategies are the only supportive therapy that clearly improve survival in patients with ARDS. […] Thus, it may be beneficial to implement protective ventilation strategies from the start of mechanical ventilation, not only when ARDS appears. […] In our opinion, preventive strategies also should include protective ventilation with low tidal volume in patients at risk, and some studies support this approach. […] The use of prophylactic PEEP in patients without ARDS is controversial. […] The strategy of reduction the time of blood storage seems reasonable to prevent nonimmune TRALI. […] It seems that early detection of patients with sepsis who are at risk of developing ARDS is one way to achieve better results in the earliest phase.

• #20 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  The following review directly addresses these practical challenges for studies of ARDS prevention and discusses potential therapies for this novel indication, including those already under investigation in early stage trials. […] Significant advances in the care of critically ill patients have decreased the incidence of ARDS over the past 20 years. […] Among key contributing measures are lung-protective ventilation, timely resuscitation and antimicrobial administration, restrictive transfusion strategies, and ventilator care bundles. […] Timely resuscitation and antimicrobial administration for sepsis, a major risk factor for ARDS, also play important roles in ARDS prevention. […] Evolving transfusion practices have also contributed to the declining incidence of ARDS. […] Measures to prevent aspiration and nosocomial pneumonia also may have contributed to the declining incidence of ARDS.

• #21 Acute respiratory distress syndrome: prevention and early recognition | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-3-11

  Beyond the etiology, certain modifiable external factors can accelerate the development of ARDS. […] Lung-protective mechanical ventilation strategies are the only supportive therapy that clearly improve survival in patients with ARDS. […] Thus, it may be beneficial to implement protective ventilation strategies from the start of mechanical ventilation, not only when ARDS appears. […] In our opinion, preventive strategies also should include protective ventilation with low tidal volume in patients at risk, and some studies support this approach. […] The use of prophylactic PEEP in patients without ARDS is controversial. […] The strategy of reduction the time of blood storage seems reasonable to prevent nonimmune TRALI. […] It seems that early detection of patients with sepsis who are at risk of developing ARDS is one way to achieve better results in the earliest phase.

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

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

  Although multiple risk factors for ARDS are known, no successful preventive measures have been identified. […] Careful fluid management in high-risk patients may be helpful. Because aspiration pneumonitis is a risk factor for ARDS, taking appropriate measures to prevent aspiration (eg, elevating the head of the bed and evaluating swallowing mechanics before feeding high-risk patients) may also prevent some ARDS cases. […] 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. […] In situations where the patient requires the use of paralyzing agents to allow certain modes of mechanical ventilation, take meticulous care to ensure that an adequate alarm system is in place to alert staff to mechanical ventilator disconnection or malfunction. In addition, adequate sedation is important in most patients on ventilators and is essential when paralytic agents are in use.

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

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

  Acute respiratory distress syndrome is believed to occur when a pulmonary or extrapulmonary insult causes the release of inflammatory mediators, promoting neutrophil accumulation in the microcirculation of the lung. […] 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. […] Conservative fluid therapy (targeting lower central pressures) in patients with ARDS may be associated with decreased days on a ventilator and increased days outside the intensive care unit. […] In addition to ventilatory measures, patients with ARDS should 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.

• #24 Medical Management and Nursing Care of a Patient with Acute Respiratory Distress Syndrome – Bezmialem Science

  https://bezmialemscience.org/articles/medical-management-and-nursing-care-of-a-patient-with-acute-respiratory-distress-syndrome/doi/bas.galenos.2021.6278

  Supportive approaches in ICU in general and in patients with ARDS, in particular, can be summarized as fluid management, nutritional support, reduction of oxygen consumption, prevention of ventilator-associated pneumonia, pain management, prevention of deep vein thrombosis, peptic ulcer prophylaxis and bleeding control, providing glycemic control and protecting and maintaining skin/tissue integrity. […] Fluid restriction in the early stages of ARDS may be beneficial in reducing pulmonary edema. […] It is significant in patients with ARDS to switch to enteral or parenteral nutrition at an early stage by evaluating the gastrointestinal system. […] One of the vital supportive strategies in patients with ARDS is to reduce oxygen consumption. […] The VAP is one of the most common complications seen in patients ventilated.

• #25 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  The following review directly addresses these practical challenges for studies of ARDS prevention and discusses potential therapies for this novel indication, including those already under investigation in early stage trials. […] Significant advances in the care of critically ill patients have decreased the incidence of ARDS over the past 20 years. […] Among key contributing measures are lung-protective ventilation, timely resuscitation and antimicrobial administration, restrictive transfusion strategies, and ventilator care bundles. […] Timely resuscitation and antimicrobial administration for sepsis, a major risk factor for ARDS, also play important roles in ARDS prevention. […] Evolving transfusion practices have also contributed to the declining incidence of ARDS. […] Measures to prevent aspiration and nosocomial pneumonia also may have contributed to the declining incidence of ARDS.

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

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

  Although multiple risk factors for ARDS are known, no successful preventive measures have been identified. […] Careful fluid management in high-risk patients may be helpful. Because aspiration pneumonitis is a risk factor for ARDS, taking appropriate measures to prevent aspiration (eg, elevating the head of the bed and evaluating swallowing mechanics before feeding high-risk patients) may also prevent some ARDS cases. […] 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. […] In situations where the patient requires the use of paralyzing agents to allow certain modes of mechanical ventilation, take meticulous care to ensure that an adequate alarm system is in place to alert staff to mechanical ventilator disconnection or malfunction. In addition, adequate sedation is important in most patients on ventilators and is essential when paralytic agents are in use.

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

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

  Acute respiratory distress syndrome is believed to occur when a pulmonary or extrapulmonary insult causes the release of inflammatory mediators, promoting neutrophil accumulation in the microcirculation of the lung. […] 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. […] Conservative fluid therapy (targeting lower central pressures) in patients with ARDS may be associated with decreased days on a ventilator and increased days outside the intensive care unit. […] In addition to ventilatory measures, patients with ARDS should 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.

• #28 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. […] Prophylaxis for venous thromboembolism should be given to all patients hospitalized with 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. […] Stress ulcer prophylaxis should also be given.

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

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

  Patients should also be on stress ulcer prophylaxis with an agent such as sucralfate (Carafate; 1 g orally or via nasogastric tube four times daily), ranitidine (Zantac; 150 mg orally or via nasogastric tube twice daily, 50 mg intravenously every six to eight hours, or a 6.25-mg-per-hour continuous intravenous infusion), or omeprazole (Prilosec; 40 mg orally, intravenously, or via nasogastric tube daily). […] The care of patients with ARDS does not end after the acute illness and often prolonged hospitalization. After discharge from the ICU, patients with ARDS tend to have a lower quality of life than they did before, significant weakness from neuropathy or myopathy, persistent cognitive impairment, and delayed return to work. […] Because the burden of illness is significant in the more than 100,000 persons who survive ARDS each year, it is imperative that primary care physicians initiate, coordinate, and monitor continuing services for these patients.

• #30 Medical Management and Nursing Care of a Patient with Acute Respiratory Distress Syndrome – Bezmialem Science

  https://bezmialemscience.org/articles/medical-management-and-nursing-care-of-a-patient-with-acute-respiratory-distress-syndrome/doi/bas.galenos.2021.6278

  Deep vein thrombosis can develop asymptomatically in ICU patients. […] Peptic ulcers, which are common in ICU patients, are caused by increased corticosteroids released in response to stress, decreased bicarbonate release, and reduced gastric blood flow. […] Stress-induced cortisol and cytokines increase hepatic gluconeogenesis, disrupt glucose utilization, and cause insulin insufficiency. […] For the dried crusts, residues around the eyes are softened by keeping the gauze soaked with warm water on the eyelid for a while. […] Although many risk factors for ARDS have been identified, there is no clear strategy for prevention so far.

• #31

  https://link.springer.com/article/10.1007/s00134-016-4280-0

  The first step to prevention of ARDS is to identify patients most likely to benefit from the prophylactic interventions. Several recent prevention studies selected patients undergoing surgical procedures in which there was substantial risk of postoperative ARDS, such as cardiac or esophageal surgeries. In these studies, the preventive interventions were delivered perioperatively, before onset of ARDS. […] A reliable biomarker-driven approach could be of great value to identify high-risk patients or to identify patients most likely to benefit from a new intervention. […] Primary prevention aims to prevent disease or injury before it occurs. For ARDS this is only feasible in patients in whom the acute injury predisposing to ARDS can be predicted, such as those undergoing elective high-risk surgery or patients who need multiple transfusions.

• #32

  https://link.springer.com/article/10.1007/s00134-016-4280-0

  The first step to prevention of ARDS is to identify patients most likely to benefit from the prophylactic interventions. Several recent prevention studies selected patients undergoing surgical procedures in which there was substantial risk of postoperative ARDS, such as cardiac or esophageal surgeries. In these studies, the preventive interventions were delivered perioperatively, before onset of ARDS. […] A reliable biomarker-driven approach could be of great value to identify high-risk patients or to identify patients most likely to benefit from a new intervention. […] Primary prevention aims to prevent disease or injury before it occurs. For ARDS this is only feasible in patients in whom the acute injury predisposing to ARDS can be predicted, such as those undergoing elective high-risk surgery or patients who need multiple transfusions.

• #33

  https://link.springer.com/article/10.1007/s00134-016-4280-0

  Secondary prevention aims to reduce the impact of a disease or injury, such as sepsis or aspiration, that has already occurred. […] Tertiary prevention aims to soften the impact of an ongoing illness or injury that may have long-lasting effects. Tertiary prevention studies in ARDS can also focus on reducing the complications and loss of function in survivors. […] There is increasing emphasis on early identification of patients at risk for ARDS and implementing strategies to prevent ARDS. There are major challenges in selecting appropriate at-risk patients, timing of interventions, study design, and outcome measures. With the recent increase in trials of preventive strategies, these challenges might be met and efficacious treatments identified. […] The focus on prevention is represented by the new US National Institutes of Health (NIH) Prevention and Early Treatment of Acute Lung Injury (PETAL) Network. This network, which succeeded the ARDS Network, is designed to conduct clinical trials of promising treatments for ARDS prevention.

• #34 Clinical Strategies to Prevent Acute Respiratory Distress Syndrome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/31060094/

  Acute respiratory distress syndrome (ARDS) remains an important clinical entity in the intensive care unit with a significant impact on morbidity and mortality. Effective therapeutic interventions are limited; thus current research focus has shifted from treatment to the prevention of this pulmonary syndrome. […] In recent decades, a decrease in the incidence of ARDS has been observed and this reduction is largely due to preventive strategies including safe lung ventilation practices, avoidance of iatrogenic exposures, and improvement in care of predisposing conditions such as sepsis and pneumonia. […] Early identification of at-risk patients, prompt treatment of predisposing conditions, and adoption of evidence-based best practice including restrictive transfusion strategies, conservative fluid management, avoidance of large tidal volume ventilation, and aspiration precaution practices are key preventive strategies with demonstrated benefits. […] There are currently no effective pharmacological preventive strategies for ARDS.

• #35 Acute respiratory distress syndrome: prevention and early recognition | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-3-11

  To date, there is no specific pharmacologic treatment for the prevention of ALI/ARDS. […] Some new strategies and preliminary studies promise to improve the early identification and early intervention to prevent the progression of the disease. […] The combination of early clinical recognition and predictive scores could help to identify patients at risk and those who might progress to mild, moderate, or severe ARDS. […] The titration of tidal volume and the duration of mechanical ventilation in patients without ARDS seem to be the best strategy for prevention.

• #36 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  Early phase multicenter randomized trials of aspirin, inhaled corticosteroids, and aerosolized 2-agonists are ongoing. […] Several preclinical and epidemiologic studies have suggested a role for aspirin in preventing ARDS. […] Supporting translation of these findings, a single-center observational study of 161 at-risk patients found that prehospitalization antiplatelet therapy was independently associated with a decreased risk for ARDS. […] The primary outcome is the development of ARDS within 7 days of hospitalization. […] Inhalation of corticosteroids may prevent ARDS through inhibition of the proinjurious inflammatory response. […] A murine model of acid aspiration-induced lung injury found that clinically relevant concentrations of 2-agonists stimulate maximal cyclic adenosine monophosphate-dependent alveolar fluid clearance and decrease pulmonary edema. […] A number of other therapies have been proposed for the prevention of ARDS among at-risk patients and have been reviewed. […] Advances in multiple aspects of critical care delivery have contributed to a substantial decline in the incidence of ARDS over the past several years.

• #37 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  Early phase multicenter randomized trials of aspirin, inhaled corticosteroids, and aerosolized 2-agonists are ongoing. […] Several preclinical and epidemiologic studies have suggested a role for aspirin in preventing ARDS. […] Supporting translation of these findings, a single-center observational study of 161 at-risk patients found that prehospitalization antiplatelet therapy was independently associated with a decreased risk for ARDS. […] The primary outcome is the development of ARDS within 7 days of hospitalization. […] Inhalation of corticosteroids may prevent ARDS through inhibition of the proinjurious inflammatory response. […] A murine model of acid aspiration-induced lung injury found that clinically relevant concentrations of 2-agonists stimulate maximal cyclic adenosine monophosphate-dependent alveolar fluid clearance and decrease pulmonary edema. […] A number of other therapies have been proposed for the prevention of ARDS among at-risk patients and have been reviewed. […] Advances in multiple aspects of critical care delivery have contributed to a substantial decline in the incidence of ARDS over the past several years.

• #38 Antiplatelet Therapy for Acute Respiratory Distress Syndrome

  https://www.mdpi.com/2227-9059/8/7/230

  The aggregation of platelets at sites of lung injury to facilitate the recruitment of neutrophils to the injured alveolus is an important mechanism in the development of ARDS. […] Aspirin has significant antiplatelet properties through the inhibition of cyclooxygenase enzymes that prevent TXA2 production, therefore suppressing platelet aggregation in animal models of acute lung injury. […] Several observational studies have shown that aspirin is protective against the development of ARDS, and a large multicenter, double-blinded, randomized study showed no beneficial effect of aspirin on the development of ARDS. […] Future research should be based on ARDS patients whose phenotype pathology is more aligned with the mechanisms of antiplatelet therapy, and specific biomarkers should be developed to track their drug response.

• #39 Antiplatelet Therapy for Acute Respiratory Distress Syndrome

  https://www.mdpi.com/2227-9059/8/7/230

  The aggregation of platelets at sites of lung injury to facilitate the recruitment of neutrophils to the injured alveolus is an important mechanism in the development of ARDS. […] Aspirin has significant antiplatelet properties through the inhibition of cyclooxygenase enzymes that prevent TXA2 production, therefore suppressing platelet aggregation in animal models of acute lung injury. […] Several observational studies have shown that aspirin is protective against the development of ARDS, and a large multicenter, double-blinded, randomized study showed no beneficial effect of aspirin on the development of ARDS. […] Future research should be based on ARDS patients whose phenotype pathology is more aligned with the mechanisms of antiplatelet therapy, and specific biomarkers should be developed to track their drug response.

• #40 Aspirin for prevention of acute respiratory distress syndrome (ARDS): let’s not throw the baby with the water!

  https://atm.amegroups.org/article/view/11433/html

  Kor et al. recently published the results of the LIPS-A trial. In this national multicenter randomized controlled trial, early aspirin administration (325 mg loading dose then 81 mg/day for 7 days) was compared to placebo in terms of reduction of acute respiratory distress syndrome (ARDS) occurrence during the first week after inclusion of patients at risk for ARDS. […] A total of 195 patients in each arm were studied. The result of this phase 2b trial was negative: ARDS occurred during the first week in 10.3% (n=20) of the patients in the intervention group versus 8.7% (n=17) in the placebo group (P=0.53). […] Aspirin is an old drug, which has been used for decades to relief pain and fever. […] In the ARDS setting, animal studies tended to prove a beneficial effect of aspirin on ARDS prevention.

• #41 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  Early phase multicenter randomized trials of aspirin, inhaled corticosteroids, and aerosolized 2-agonists are ongoing. […] Several preclinical and epidemiologic studies have suggested a role for aspirin in preventing ARDS. […] Supporting translation of these findings, a single-center observational study of 161 at-risk patients found that prehospitalization antiplatelet therapy was independently associated with a decreased risk for ARDS. […] The primary outcome is the development of ARDS within 7 days of hospitalization. […] Inhalation of corticosteroids may prevent ARDS through inhibition of the proinjurious inflammatory response. […] A murine model of acid aspiration-induced lung injury found that clinically relevant concentrations of 2-agonists stimulate maximal cyclic adenosine monophosphate-dependent alveolar fluid clearance and decrease pulmonary edema. […] A number of other therapies have been proposed for the prevention of ARDS among at-risk patients and have been reviewed. […] Advances in multiple aspects of critical care delivery have contributed to a substantial decline in the incidence of ARDS over the past several years.

• #42 Are there risk factors and preventative interventions for acute respiratory distress syndrome (ARDS) in COVID-19? | The Centre for Evidence-Based Medicine

  https://www.cebm.net/covid-19/are-there-risk-factors-and-preventative-interventions-for-acute-respiratory-distress-syndrome-ards-in-covid-19/

  However, their results do perhaps provide inspiration for the types of risk factors to be examined in more depth. […] The results for other comorbidities, symptoms and previous drug therapy were more mixed. […] One pre/post study (8) of the introduction of an early short course of corticosteroids, finding a statistically significant ARDS free survival in the control group. […] However, this study had several major limitations, for instance over half the pre-protocol group also received steroids just later in their admission.

• #43 Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS) in adults: meta-analysis | The BMJ

  https://www.bmj.com/content/336/7651/1006

  Objective To systematically review the efficacy of steroids in the prevention of acute respiratory distress syndrome (ARDS) in critically ill adults, and treatment for established ARDS. […] Preventive steroids possibly increase the incidence of ARDS in critically ill adults. […] The credible interval for the preventive use of steroids in critically ill patients included 1, indicating that a null effect could not be ruled out. The probability (odds ratio 1) was 86.6% suggesting some evidence of an association between steroid therapy and the subsequent development of ARDS: four studies, odds ratio 1.55 (95% credible interval 0.58 to 4.05); SD 0.58 for variability between studies. […] Although preventive steroid therapy in critically ill patients may have been associated with detrimental effects on the incidence of ARDS and subsequent mortality, a trend was found to benefit when steroids were given after the onset of ARDS; in particular, a reduction in odds of mortality (probability of reduction 93.2%). […] Some evidence exists for the efficacy of steroid use after the onset of ARDS, without notable side effects such as new infection. We cannot, however, dismiss a null effect.

• #44 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  Early phase multicenter randomized trials of aspirin, inhaled corticosteroids, and aerosolized 2-agonists are ongoing. […] Several preclinical and epidemiologic studies have suggested a role for aspirin in preventing ARDS. […] Supporting translation of these findings, a single-center observational study of 161 at-risk patients found that prehospitalization antiplatelet therapy was independently associated with a decreased risk for ARDS. […] The primary outcome is the development of ARDS within 7 days of hospitalization. […] Inhalation of corticosteroids may prevent ARDS through inhibition of the proinjurious inflammatory response. […] A murine model of acid aspiration-induced lung injury found that clinically relevant concentrations of 2-agonists stimulate maximal cyclic adenosine monophosphate-dependent alveolar fluid clearance and decrease pulmonary edema. […] A number of other therapies have been proposed for the prevention of ARDS among at-risk patients and have been reviewed. […] Advances in multiple aspects of critical care delivery have contributed to a substantial decline in the incidence of ARDS over the past several years.

• #45 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  Early phase multicenter randomized trials of aspirin, inhaled corticosteroids, and aerosolized 2-agonists are ongoing. […] Several preclinical and epidemiologic studies have suggested a role for aspirin in preventing ARDS. […] Supporting translation of these findings, a single-center observational study of 161 at-risk patients found that prehospitalization antiplatelet therapy was independently associated with a decreased risk for ARDS. […] The primary outcome is the development of ARDS within 7 days of hospitalization. […] Inhalation of corticosteroids may prevent ARDS through inhibition of the proinjurious inflammatory response. […] A murine model of acid aspiration-induced lung injury found that clinically relevant concentrations of 2-agonists stimulate maximal cyclic adenosine monophosphate-dependent alveolar fluid clearance and decrease pulmonary edema. […] A number of other therapies have been proposed for the prevention of ARDS among at-risk patients and have been reviewed. […] Advances in multiple aspects of critical care delivery have contributed to a substantial decline in the incidence of ARDS over the past several years.

• #46 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  Early phase multicenter randomized trials of aspirin, inhaled corticosteroids, and aerosolized 2-agonists are ongoing. […] Several preclinical and epidemiologic studies have suggested a role for aspirin in preventing ARDS. […] Supporting translation of these findings, a single-center observational study of 161 at-risk patients found that prehospitalization antiplatelet therapy was independently associated with a decreased risk for ARDS. […] The primary outcome is the development of ARDS within 7 days of hospitalization. […] Inhalation of corticosteroids may prevent ARDS through inhibition of the proinjurious inflammatory response. […] A murine model of acid aspiration-induced lung injury found that clinically relevant concentrations of 2-agonists stimulate maximal cyclic adenosine monophosphate-dependent alveolar fluid clearance and decrease pulmonary edema. […] A number of other therapies have been proposed for the prevention of ARDS among at-risk patients and have been reviewed. […] Advances in multiple aspects of critical care delivery have contributed to a substantial decline in the incidence of ARDS over the past several years.

• #47 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  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. […] Current initiatives have broadened the scope of lung injury research to include primary prevention of ARDS and prevention of morbidity among ARDS survivors. […] To facilitate these efforts, the National Institutes of Health has formed the Prevention and Early Treatment of Acute Lung Injury (PETAL) Network to conduct multicenter clinical trials aimed at further decreasing the disease burden of ARDS. […] Clinical trials targeting the prevention of ARDS face several key design challenges.

• #48 ARDS: Causes, Symptoms, Risks, Diagnosis, and TreatmentHealthline

  https://www.healthline.com/health/acute-respiratory-distress-syndrome

  There’s no way to prevent ARDS completely. However, you may be able to lower your risk of ARDS by doing the following: […] Seek prompt medical assistance for any trauma, infection, or illness. […] If you smoke, consider stopping smoking cigarettes. […] Try to stay away from secondhand smoke. […] Avoid alcohol. Chronic alcohol use may increase your mortality risk and prevent proper lung function. […] Get your flu vaccine annually and pneumonia vaccine every 5 years. This decreases your risk of lung infections.

• #49

  https://www.advocatehealth.com/health-services/lung-respiratory-care/acute-respiratory-distress-syndrome-ards

  Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition that causes low oxygen levels in the blood. […] You can lower your risk of ARDS by avoiding tobacco smoke, limiting alcohol, limiting exposure to pollution, and getting vaccinated for the flu, COVID and other infections.

• #50 Understanding Acute Respiratory Distress Syndrome (ARDS) 

  http://library.oumedicine.com/Search/3,90903

  You can lower your risk for ARDS by: […] Staying up-to-date on vaccines, such as for flu and COVID-19. Ask your healthcare provider which are right for you. […] Don’t smoke. Ask your healthcare team for help quitting. […] Limit alcohol. Men should have no more than 2 drinks per day. Women should have no more than 1 drink per day. […] Limit exposure to pollution if possible.

• #51 Acute Respiratory Distress Syndrome (ARDS) | Baptist Health

  https://www.baptisthealth.com/care-services/conditions-treatments/acute-respiratory-distress-syndrome

  You can help prevent ARDS with lifestyle changes. However, there is no scientifically proven way to entirely prevent ARDS. […] ARDS prevention: […] Get medical care quickly. […] Stay up to date with your flu and pneumonia vaccines. […] Quit smoking and using any tobacco products. […] Avoid secondhand smoke. […] Reduce alcohol use or stop all alcohol use.

• #52 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  In a single-center study, implementation of protocol-guided tidal volume and transfusion management was associated with a significantly lower incidence of ARDS. […] The utility of adopting CLIP as a patient-level checklist may vary depending on an institution’s local practices, but the measures in CLIP should be viewed as the current best practice for ARDS prevention. […] Investigating new therapies targeting ARDS prevention necessitates reliable early identification of patients at risk for lung injury. […] A LIPS totaling 4 points has a sensitivity of 0.69, specificity of 0.78, positive predictive value of 0.18, and negative predictive value of 0.97. […] More recently, angiopoietin-2 used together with LIPS was shown to predict subsequent development of ARDS better than either alone.

• #53 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  In a single-center study, implementation of protocol-guided tidal volume and transfusion management was associated with a significantly lower incidence of ARDS. […] The utility of adopting CLIP as a patient-level checklist may vary depending on an institution’s local practices, but the measures in CLIP should be viewed as the current best practice for ARDS prevention. […] Investigating new therapies targeting ARDS prevention necessitates reliable early identification of patients at risk for lung injury. […] A LIPS totaling 4 points has a sensitivity of 0.69, specificity of 0.78, positive predictive value of 0.18, and negative predictive value of 0.97. […] More recently, angiopoietin-2 used together with LIPS was shown to predict subsequent development of ARDS better than either alone.

• #54 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

  R1.1 – The experts suggest that the efficacy and safety of all ventilation parameters and therapeutics associated with ARDS management should be evaluated at least every 24 h. […] R2.1.1 A tidal volume around 6 mL/kg of predicted body weight (PBW) should be used as a first approach in patients with recognized ARDS, in the absence of severe metabolic acidosis, including those with mild ARDS, to reduce mortality. […] R3.1.1 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. […] R5.1 Prone positioning should be used in ARDS patients with PaO2/FiO2 ratio 150 mmHg to reduce mortality. Sessions of at least 16 consecutive hours should be performed. […] R6.1 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.

• #55 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  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. […] Current initiatives have broadened the scope of lung injury research to include primary prevention of ARDS and prevention of morbidity among ARDS survivors. […] To facilitate these efforts, the National Institutes of Health has formed the Prevention and Early Treatment of Acute Lung Injury (PETAL) Network to conduct multicenter clinical trials aimed at further decreasing the disease burden of ARDS. […] Clinical trials targeting the prevention of ARDS face several key design challenges.

• #56 Are there risk factors and preventative interventions for acute respiratory distress syndrome (ARDS) in COVID-19? | The Centre for Evidence-Based Medicine

  https://www.cebm.net/covid-19/are-there-risk-factors-and-preventative-interventions-for-acute-respiratory-distress-syndrome-ards-in-covid-19/

  Seventeen studies were included in this rapid review (117), with older age, diabetes, certain blood tests and African American ethnicity amongst the most evidenced risk factors for ARDS. […] In short, we found a lack of robust data regarding risk factors or prevention of COVID-19 ARDS and identified an urgent need for high quality research in this area. […] Given the potential severity of ARDS, being alert to which patients are at an increased risk of ARDS or being aware of interventions to reduce the likelihood of ARDS has the potential to be influential in clinical practice. […] This review focuses on COVID-19 specific knowledge and aims to determine if there are any known risk factors for ARDS in this infection and whether there are any interventions to prevent ARDS developing. […] There remains significant scope and need for studies to robustly determine risk factors and preventative interventions for ARDS in COVID-19.

• #57 The acute respiratory distress syndrome: a clinical review – Aronson – Journal of Emergency and Critical Care Medicine

  https://jeccm.amegroups.org/article/view/3832/html

  The goal of future research to focus on prevention of the disease in a multidisciplinary fashion. […] The purpose of this network is to develop innovative approaches to prevent and improve outcomes of patients at risk for ARDS. […] Strategies to optimize vaccination of patients for influenza and pneumococcus, as well as proper practice of aspiration precautions, early recognition of sepsis, reduction of excessive fluid administration, and restrictive transfusion protocols are all high yield areas of research. […] The critical care community is now focused on conducting trials that will assist with uncovering strategies aimed at prevention of the disease.

• #58 The acute respiratory distress syndrome: a clinical review – Aronson – Journal of Emergency and Critical Care Medicine

  https://jeccm.amegroups.org/article/view/3832/html

  The goal of future research to focus on prevention of the disease in a multidisciplinary fashion. […] The purpose of this network is to develop innovative approaches to prevent and improve outcomes of patients at risk for ARDS. […] Strategies to optimize vaccination of patients for influenza and pneumococcus, as well as proper practice of aspiration precautions, early recognition of sepsis, reduction of excessive fluid administration, and restrictive transfusion protocols are all high yield areas of research. […] The critical care community is now focused on conducting trials that will assist with uncovering strategies aimed at prevention of the disease.

• #59 Medical Countermeasures | BARDA selects novel therapeutic candidates to evaluate in platform clinical trial for acute respiratory distress syndrome treatment

  https://medicalcountermeasures.gov/newsroom/2024/ards/

  BARDA has selected host-directed therapeutic candidates for inclusion in a phase 2 platform clinical trial to address acute respiratory distress syndrome (ARDS). Currently, no treatments are approved by the U.S. Food and Drug Administration (FDA) for ARDS. […] ARDS is a life-threatening lung condition with multiple causes, including severe pneumonia and sepsis due to bacterial and viral infections such as influenza and SARS-CoV-2. ARDS can lead to high rates of death among hospitalized patients or to long-term complications for patients who recover. Since ARDS has multiple root causes, identifying new treatments for patients remains challenging. Therefore, there is an urgent need to understand its clinical and biological features to better classify patients into sub-phenotypes that might be more responsive to a specific therapeutic.

• #60 Medical Countermeasures | BARDA selects novel therapeutic candidates to evaluate in platform clinical trial for acute respiratory distress syndrome treatment

  https://medicalcountermeasures.gov/newsroom/2024/ards/

  In December 2023, BARDA awarded a multimillion-dollar contract to PPD Development, LP, (the PPD clinical research business of Thermo Fisher Scientific Inc.) to implement the BARDA clinical trial over the span of three years. The randomized, double-blind, placebo-controlled, multicenter phase 2 platform clinical trial will evaluate the safety and efficacy of the selected host-directed therapeutics at up to 60 U.S. clinical sites, enrolling 600 hospitalized adult patients with ARDS. […] Through this phase 2 study, BARDA will build a strong platform capability to investigate potential therapeutics for ARDS caused by known or unknown health security threats such as pandemic influenza, COVID-19, other emerging infectious diseases, and chemical, biological, radiological, and nuclear (CBRN) incidents. In addition, positive results from the study may be used to design a phase 3 efficacy trial.

• #61 Acute respiratory distress syndrome: prevention and early recognition | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-3-11

  Acute respiratory distress syndrome (ARDS) is common in critically ill patients admitted to intensive care units (ICU). […] Research focusing on preventing ARDS and identifying patients at risk of developing ARDS is necessary to develop strategies to alter the clinical course and progression of the disease. […] Identifying patients at risk and implementing prevention strategies in this group are key factors in preventing ARDS. […] The first obstacle to preventing ARDS is identifying patients at risk of developing ARDS. […] Implementing preventive measures requires an algorithm for early detection. […] The combination of early clinical recognition and predictive scores could help in the detection of patients at-risk and in the early treatment or implementation of preventive strategies.

• #62 Acute respiratory distress syndrome: prevention and early recognition | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-3-11

  Acute respiratory distress syndrome (ARDS) is common in critically ill patients admitted to intensive care units (ICU). […] Research focusing on preventing ARDS and identifying patients at risk of developing ARDS is necessary to develop strategies to alter the clinical course and progression of the disease. […] Identifying patients at risk and implementing prevention strategies in this group are key factors in preventing ARDS. […] The first obstacle to preventing ARDS is identifying patients at risk of developing ARDS. […] Implementing preventive measures requires an algorithm for early detection. […] The combination of early clinical recognition and predictive scores could help in the detection of patients at-risk and in the early treatment or implementation of preventive strategies.

• #63 Preventing ARDS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4188145/

  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. […] Current initiatives have broadened the scope of lung injury research to include primary prevention of ARDS and prevention of morbidity among ARDS survivors. […] To facilitate these efforts, the National Institutes of Health has formed the Prevention and Early Treatment of Acute Lung Injury (PETAL) Network to conduct multicenter clinical trials aimed at further decreasing the disease burden of ARDS. […] Clinical trials targeting the prevention of ARDS face several key design challenges.

• #64 Are there risk factors and preventative interventions for acute respiratory distress syndrome (ARDS) in COVID-19? | The Centre for Evidence-Based Medicine

  https://www.cebm.net/covid-19/are-there-risk-factors-and-preventative-interventions-for-acute-respiratory-distress-syndrome-ards-in-covid-19/

  Seventeen studies were included in this rapid review (117), with older age, diabetes, certain blood tests and African American ethnicity amongst the most evidenced risk factors for ARDS. […] In short, we found a lack of robust data regarding risk factors or prevention of COVID-19 ARDS and identified an urgent need for high quality research in this area. […] Given the potential severity of ARDS, being alert to which patients are at an increased risk of ARDS or being aware of interventions to reduce the likelihood of ARDS has the potential to be influential in clinical practice. […] This review focuses on COVID-19 specific knowledge and aims to determine if there are any known risk factors for ARDS in this infection and whether there are any interventions to prevent ARDS developing. […] There remains significant scope and need for studies to robustly determine risk factors and preventative interventions for ARDS in COVID-19.

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