Materiały źródłowe

• #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.

• #2

• #3 ARDS Treatment and Recovery | American Lung Association

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

  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. Oxygen alone is usually not enough, and high levels of oxygen can also injure the lung. A ventilator is a machine used to open airspaces that have shut down and help with the work of breathing. The ventilator is connected to the patient through a mask on the face or a tube inserted into the windpipe. […] ARDS patients are typically in bed on their back. 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. This is called proning and may help improve oxygen levels in the blood for a while. It is a complicated task and some patients are too sick for this treatment.

• #4 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.

• #5 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 can be given for a short or long period of time in the hospital, in another medical setting, or at home. […] 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.

• #6 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.

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

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

  Because intubation and mechanical ventilation may be associated with an increased incidence of complications, such as barotrauma and nosocomial pneumonia, alternatives to mechanical ventilation such as a high-flow nasal cannula or noninvasive positive-pressure ventilation (NIPPV) may be beneficial in patients with ARDS. […] High-flow nasal cannula is usually well tolerated and allows the patient to talk, eat, and move around. […] In a 2015 study on hypoxemic, nonhypercapnic patients comparing standard oxygen, high-flow nasal cannula, and NIPPV, all three modes had the same incidence of need for intubation/mechanical ventilation, but high-flow nasal cannula resulted in improved 90-day mortality. […] The goals of mechanical ventilation in ARDS are to maintain oxygenation while avoiding oxygen toxicity and the complications of mechanical ventilation.

• #8 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 can be given for a short or long period of time in the hospital, in another medical setting, or at home. […] 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.

• #9

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

  The basics of treating ARDS are to repair the injury to the lungs, get enough oxygen into your blood so your body can work correctly and then wait for the lungs to heal. […] Your acute respiratory distress syndrome treatment may include noninvasive breathing support supplied using CPAP (continuous positive airway pressure) or BiPAP (bilevel positive airway pressure) machines. These devices are relatively low-risk options. […] In case of severe breathing problems, you may be placed on an automatic ventilator to assist your breathing. Using a tight-fitting mask or an endotracheal tube inserted into your windpipe, the ventilator moves air or air enriched with oxygen into and out of your lungs. […] Being on a ventilator for ARDS treatment may last for a week or two. […] In some of our ICUs, extracorporeal membrane oxygenation (ECMO) may also be used for ARDS treatment. ECMO is a bypass procedure that uses a machine to circulate blood and oxygen through your body.

• #10 ARDS Treatment and Recovery | American Lung Association

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

  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. Oxygen alone is usually not enough, and high levels of oxygen can also injure the lung. A ventilator is a machine used to open airspaces that have shut down and help with the work of breathing. The ventilator is connected to the patient through a mask on the face or a tube inserted into the windpipe. […] ARDS patients are typically in bed on their back. 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. This is called proning and may help improve oxygen levels in the blood for a while. It is a complicated task and some patients are too sick for this treatment.

• #11 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.

• #12 Management of ARDS – What Works and What Does Not

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7997862/

  Lung protective ventilation is the cornerstone of ARDS management. […] It is strongly recommended to use lung protective ventilation (tidal volume of 4-8 mL/Kg of predicted body weight and to maintain plateau pressure of 30 cm H2O) in all ARDS patients. […] As mentioned above, low tidal volume ventilation to prevent tidal hyperinflation and application of positive end expiratory pressure (PEEP) to prevent atelectrauma are the main components of lung protective ventilation in patients with ARDS. […] In summary, while PEEP is recommended in all patients with ARDS, high PEEP may be considered on a case-by-case basis (conditional recommendation) in patients with moderate to severe ARDS. […] A recruitment maneuver is a ventilator intervention to transiently increase airway pressure to open the collapsed alveoli, thereby improving oxygenation and volume distribution.

• #13 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.

• #14 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.

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

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

  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. […] Low tidal volume, high positive end-expiratory pressure, and conservative fluid therapy may improve outcomes. […] When mechanical ventilation is required, patients with ARDS should be started at lower tidal volumes (6 mL per kg) instead of at traditional volumes (10 to 15 mL per kg). […] Higher positive end-expiratory pressure values (12 to 18 or more cm H2O) should be considered for initial mechanical ventilation in patients with ARDS. […] 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.

• #16 Management of ARDS – What Works and What Does Not

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7997862/

  Lung protective ventilation is the cornerstone of ARDS management. […] It is strongly recommended to use lung protective ventilation (tidal volume of 4-8 mL/Kg of predicted body weight and to maintain plateau pressure of 30 cm H2O) in all ARDS patients. […] As mentioned above, low tidal volume ventilation to prevent tidal hyperinflation and application of positive end expiratory pressure (PEEP) to prevent atelectrauma are the main components of lung protective ventilation in patients with ARDS. […] In summary, while PEEP is recommended in all patients with ARDS, high PEEP may be considered on a case-by-case basis (conditional recommendation) in patients with moderate to severe ARDS. […] A recruitment maneuver is a ventilator intervention to transiently increase airway pressure to open the collapsed alveoli, thereby improving oxygenation and volume distribution.

• #17 ARDS Treatment and Recovery | American Lung Association

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

  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. Oxygen alone is usually not enough, and high levels of oxygen can also injure the lung. A ventilator is a machine used to open airspaces that have shut down and help with the work of breathing. The ventilator is connected to the patient through a mask on the face or a tube inserted into the windpipe. […] ARDS patients are typically in bed on their back. 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. This is called proning and may help improve oxygen levels in the blood for a while. It is a complicated task and some patients are too sick for this treatment.

• #18 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. […] 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%).

• #19 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.

• #20 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. […] 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%).

• #21 ARDS Treatment and Recovery | American Lung Association

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

  To relieve shortness of breath and prevent agitation, the ARDS patient usually needs sedation. Sometimes added medications called paralytics are needed up front to help the patient adjust to the ventilator. These medications have significant side effects and their risks and benefits must be continuously monitored. […] 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. This must be done carefully, because too much fluid removal can lower blood pressure and lead to kidney problems. […] 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. This is a high-risk therapy with many potential complications. It is not suitable for every ARDS patient.

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

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

  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. This can be very complicated and takes a whole team to do, and some patients may be too sick for it. There are special beds in the intensive care unit designed to help position patients facedown. […] ECMO: a complex treatment that takes blood outside of the patients body, adds oxygen and removes carbon dioxide, and then returns it.

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

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

  ECMO involves using a venoarterial or venovenous circuit to remove blood from the body, introduce oxygen and remove carbon dioxide, then return the blood to the body. […] The role of corticosteroids is controversial. […] 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. […] Patients with an anticipated ventilation requirement of at least 72 hours should be started on enteral nutrition. […] The American Thoracic Society and American College of Chest Physicians recommend a ventilator liberation protocol (also known as a weaning protocol) for patients who have been on mechanical ventilation for more than 24 hours. […] Patients on ventilators should be encouraged to participate in mobilization therapy consisting of range-of-motion or resistance activities, sitting, or standing.

• #24 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 it is evident that NMB improves oxygenation, it is controversial whether it confers a mortality benefit. […] 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.

• #25 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.

• #26 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.

• #27 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

  A neuromuscular blocking agent should probably be considered in ARDS patients with a PaO2/FiO2 ratio 150 mmHg to reduce mortality. […] 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 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.

• #28 ARDS Treatment and Recovery | American Lung Association

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

  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. Oxygen alone is usually not enough, and high levels of oxygen can also injure the lung. A ventilator is a machine used to open airspaces that have shut down and help with the work of breathing. The ventilator is connected to the patient through a mask on the face or a tube inserted into the windpipe. […] ARDS patients are typically in bed on their back. 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. This is called proning and may help improve oxygen levels in the blood for a while. It is a complicated task and some patients are too sick for this treatment.

• #29 Acute Respiratory Distress Syndrome (ARDS)

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

  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.

• #30 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.

• #31 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 it is evident that NMB improves oxygenation, it is controversial whether it confers a mortality benefit. […] 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.

• #32 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.

• #33 Management of ARDS – What Works and What Does Not

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7997862/

  The traditional ventilator modes that are commonly used for patients with ARDS include pressure-controlled ventilation (PCV) or volume-controlled ventilation (VCV). […] Over the last two decades multiple pharmacological agents have been studied in the management of ARDS. […] Due to their potent anti-inflammatory activity, systemic corticosteroids have been of huge interest in the treatment of patients with ARDS. […] In conclusion, early administration of corticosteroids within 14 days of onset of moderate to severe ARDS can reduce the duration of mechanical ventilation and overall mortality and should be considered in such patients provided no contraindications. […] Prone positioning for more than 12 h/day is strongly recommended in ventilated patients with severe ARDS. […] In conclusion, the use of ECMO should be considered in a select number of patients with severe ARDS on lung protective ventilation with Murray Score 3 or pH 7.2 due to uncompensated hypercapnia.

• #34 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.

• #35 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.

• #36 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.

• #37 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). […] Inhaled pulmonary vasodilators were also considered potential pharmacotherapies. […] Inhaled nitric oxide (NO), a potent pulmonary vasodilator, seemed promising in early trials, but in larger controlled trials, it did not change mortality rates in adults with ARDS. […] A systematic review, meta-analysis, and trial sequential analysis of 14 randomized controlled trials, including 1303 patients, found that inhaled nitric oxide did not reduce mortality and results in only a transient improvement in oxygenation. […] Similarly, inhaled prostaglandins improved oxygenation but had no impact on mortality. […] Neuromuscular blockers (NMBs) have been investigated to address the challenges of achieving low-tidal volume ventilation and ventilatory synchrony with ARDS.

• #38 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 it is evident that NMB improves oxygenation, it is controversial whether it confers a mortality benefit. […] 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.

• #39 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

  A neuromuscular blocking agent should probably be considered in ARDS patients with a PaO2/FiO2 ratio 150 mmHg to reduce mortality. […] 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 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.

• #40 ARDS Treatment and Recovery | American Lung Association

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

  To relieve shortness of breath and prevent agitation, the ARDS patient usually needs sedation. Sometimes added medications called paralytics are needed up front to help the patient adjust to the ventilator. These medications have significant side effects and their risks and benefits must be continuously monitored. […] 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. This must be done carefully, because too much fluid removal can lower blood pressure and lead to kidney problems. […] 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. This is a high-risk therapy with many potential complications. It is not suitable for every ARDS patient.

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

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

  Ultimately, there are conflicting recommendations on routine use of NMBs based upon the lack of robust evidence. […] Numerous other pharmacologic therapies, including the use of inhaled synthetic surfactant, intravenous (IV) antibody to endotoxin, interferon-beta-1a, IV prostaglandin E1, neutrophil elastase inhibitors, ketoconazole, simvastatin, and ibuprofen, have been tried and are not effective. […] 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.

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

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

  Surfactant therapy does not improve mortality in adults with ARDS. […] 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. […] 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.

• #43 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.

• #44 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). […] Finally, patients should receive nutritional support, preferably enteral, within 24 to 48 hours of admission to the ICU.

• #45 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.

• #46 Acute Respiratory Distress Syndrome (ARDS)

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

  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.

• #47 The Role of Physical Therapy in ARDS Recovery – ARDSAlliance.org

  https://ardsalliance.org/the-role-of-physical-therapy-in-ards-recovery/

  Acute Respiratory Distress Syndrome (ARDS) is a life-threatening condition characterized by widespread inflammation in the lungs, leading to severe breathing difficulties. […] One critical aspect of ARDS recovery that often doesn’t receive enough attention is physical therapy. […] Understanding the sequelae of ARDS, which includes physical deconditioning, cognitive dysfunction, and emotional distress, is crucial for recognition of the importance of comprehensive rehabilitation, including physical therapy. The intervention of physical therapists during and after the acute phase can improve patients’ functional outcomes and quality of life. […] One of the most effective strategies in physical therapy for ARDS patients is early mobilization. […] Research has shown that initiating movement and physical activity as early as possible during an ICU stay can dramatically improve recovery outcomes.

• #48 The Role of Physical Therapy in ARDS Recovery – ARDSAlliance.org

  https://ardsalliance.org/the-role-of-physical-therapy-in-ards-recovery/

  Acute Respiratory Distress Syndrome (ARDS) is a life-threatening condition characterized by widespread inflammation in the lungs, leading to severe breathing difficulties. […] One critical aspect of ARDS recovery that often doesn’t receive enough attention is physical therapy. […] Understanding the sequelae of ARDS, which includes physical deconditioning, cognitive dysfunction, and emotional distress, is crucial for recognition of the importance of comprehensive rehabilitation, including physical therapy. The intervention of physical therapists during and after the acute phase can improve patients’ functional outcomes and quality of life. […] One of the most effective strategies in physical therapy for ARDS patients is early mobilization. […] Research has shown that initiating movement and physical activity as early as possible during an ICU stay can dramatically improve recovery outcomes.

• #49 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

  Lung-protective ventilation (i.e., tidal volumes of 6ml/kg of predicted body weight and plateau pressure 30mm Hg) is a key recommendation based on the findings of the landmark ARMA trial, which showed reduced mortality and increased ventilation-free days. […] The use of NMB in patients with moderate to severe ARDS has the potential benefit of decreasing ventilator-associated lung injury and improving mortality at 28 days without increasing the incidence of neuromuscular weakness. […] 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). […] To date, many clinical studies have demonstrated the benefits of different MSC treatments in ARDS patients, as indicated by reduced inflammation and alveolar permeability and improved lung function, including tidal volume and compliance.

• #50

  https://link.springer.com/article/10.1007/s00134-020-06141-z

  A number of medications with a broad base of pleiotropic immunomodulatory effects are in clinical trials for the treatment of ARDS or to prevent ARDS development. […] Steroids have long been studied as a potential therapy for both early and late phase ARDS, with some studies suggesting potential benefit, via suppression of the pro-inflammatory cytokine response, while other studies demonstrating potential risks due to immune suppression. […] A recent interesting open-label multicenter study examined the efficacy of high-dose dexamethasone regimen in patients with established moderate to severe ARDS. […] Ulinastatin is a urinary glycoprotein and protease inhibitor with potent antioxidant and anti-inflammatory effects. […] 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.

• #51 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

  Lung-protective ventilation (i.e., tidal volumes of 6ml/kg of predicted body weight and plateau pressure 30mm Hg) is a key recommendation based on the findings of the landmark ARMA trial, which showed reduced mortality and increased ventilation-free days. […] The use of NMB in patients with moderate to severe ARDS has the potential benefit of decreasing ventilator-associated lung injury and improving mortality at 28 days without increasing the incidence of neuromuscular weakness. […] 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). […] To date, many clinical studies have demonstrated the benefits of different MSC treatments in ARDS patients, as indicated by reduced inflammation and alveolar permeability and improved lung function, including tidal volume and compliance.

• #52 Cell therapy in acute respiratory distress syndrome – Horie – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/23940/html

  There is a pressing need for a safe and effective treatment for ARDS and attention has turned to the use of cell therapy. […] MSCs have already shown therapeutic efficacy in preclinical models and exhibited safety clinically in a number of phase I trials. […] While MSCs are traditionally isolated from BM, they can also been found in many other adult tissues such as lung, liver, cord blood, placenta, dental pulp and AD, providing alternative, more readily available and cheaper sources of MSCs. […] It was recently demonstrated that UC-MSCs could protect against LPS-induced lung injury in a mouse model, with examination of the MSC secretome and identification of factors responsible for the immune regulation leading to a beneficial outcome. […] Numerous pre-clinical ARDS and sepsis studies have shown that MSCs reduce the infiltration of neutrophils to the damaged tissue while also enhancing neutrophil-mediated phagocytosis and thus bacterial clearance.

• #53 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

  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. […] The marked expansion in testing of anti-inflammatory biologics for the treatment of both conditions is likely because inflammation has been identified as part of the detrimental pathology of CARDS. […] CERC-002 significantly increased the number of CARDS patients free of respiratory failure by day 28.

• #54

  https://link.springer.com/article/10.1007/s00134-020-06141-z

  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. […] ARDS is a disorder involving injury and dysfunction of the pulmonary epithelium and endothelium, with resultant dysfunction of the alveolar-capillary barrier leading to lung edema. […] Consequently, targeting epithelial ion channels/channel dysfunction and endothelial/vascular dysfunction in ARDS constitute an important therapeutic target. […] 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.

• #55 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

  However, no efficacy of MSCs in patients with CARDS was demonstrated in two trials. […] 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. […] Targeted immunotherapy has emerged as a promising approach for treating ARDS; however, several challenges must be overcome to maximize its therapeutic potential. […] The heterogeneity of ARDS presents a significant challenge in identifying specific therapeutic targets that can benefit all patients uniformly. […] The future of ARDS management will move towards identifying biological phenotypes and traits associated with treatment response and delivering personalized therapeutic interventions.

• #56 Promises and challenges of personalized medicine to guide ARDS therapy | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-021-03822-z

  Identifying new effective treatments for the acute respiratory distress syndrome (ARDS), including COVID-19 ARDS, remains a challenge. The field of ARDS investigation is moving increasingly toward innovative approaches such as the personalization of therapy to biological and clinical sub-phenotypes. […] This review highlights emerging opportunities and continued challenges for personalizing therapy for ARDS, from identifying treatable traits to innovative clinical trial design and recognition of patient-level factors as the field of critical care investigation moves forward into the twenty-first century. […] Personalized medicine in ARDS is inherently challenging because of heterogeneous etiology and pathophysiology. […] ARDS research need not focus exclusively on novel investigational therapies, as repurposing drugs that have been studied in untargeted/unenriched populations could be just as innovative and promising, including for COVID-19 ARDS. […] Opportunities for targeting therapies include timing, clinical phenotypes, and biologic phenotypes. […] Adaptive clinical trial design offers the chance to investigate multiple therapies quickly and flexibly. […] Supportive interventions, such as ventilator management and fluid strategy, can also potentially be personalized. […] Though existing drugs and supportive care strategies may be repurposed/targeted, novel therapies are also on the horizon.

• #57 Acute Respiratory Distress Syndrome (ARDS)

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

  Pulmonary rehabilitation to help strengthen your lungs and increase lung capacity. […] 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. […] Recovery from ARDS may take a long time. Most people who are taken off a ventilator can breathe freely. Some recover completely, but others may develop chronic lung problems that require care by lung specialists (pulmonologists).

• #58 Acute Respiratory Distress Syndrome (ARDS)

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

  Pulmonary rehabilitation to help strengthen your lungs and increase lung capacity. […] 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. […] Recovery from ARDS may take a long time. Most people who are taken off a ventilator can breathe freely. Some recover completely, but others may develop chronic lung problems that require care by lung specialists (pulmonologists).

• #59 ARDS Treatment and Recovery | American Lung Association

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

  ARDS patients may require ventilation for long periods of time. On average this is seven to 14 days. Beyond this time, doctors may suggest a tube be placed directly into the windpipe through the neck (tracheostomy) by a surgeon. Usually the doctor believes it may take weeks more to recover from ventilator support. This tube can easily be removed once the patient is free of the need for a ventilator. 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. Others will struggle with muscle weakness and may require re-hospitalization or pulmonary rehabilitation to regain their strength.

• #60 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

  In recent years, the incidence of acute respiratory distress syndrome (ARDS) has been gradually increasing. Despite advances in supportive care, ARDS remains a significant cause of morbidity and mortality in critically ill patients. […] In this review, we comprehensively discuss the latest advancements in ARDS research, focusing on its heterogeneity, pathophysiological mechanisms, and emerging therapeutic approaches, such as cellular therapy, immunotherapy, and targeted therapy. […] Recent advances in research have yielded significant progress, particularly in the area of cell therapy. Mesenchymal stromal cells (MSCs), for example, have emerged as a promising therapeutic option due to their unique immunomodulatory and regenerative properties. […] In the realm of targeted therapy, scientists have been painstakingly investigating specific molecular pathways implicated in ARDS pathogenesis.

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