Pharmacological management of adult patients with acute respiratory distress syndrome

ABSTRACT

Introduction

There is still no definite drug for acute respiratory distress syndrome (ARDS) that is capable of reducing either short-term or long-term mortality. Therefore, great efforts are being made to identify a pharmacological approach that can be really effective.

Areas covered

This review focuses on current challenges and future directions in the pharmacological management of ARDS, regardless of anti-infective treatments. The authors have excluded small randomized controlled trials (RCTs) with less than 60 patients because those studies do not have statistical power for outcome data, and also anecdotal trials but have considered the last meta-analysis on any drug.

Expert opinion

There has been substantial progress in our knowledge of ARDS over the past two decades and many drugs have been used in its treatment. Nevertheless, effective targeted pharmacological treatments for ARDS are still lacking. The likely reason why a pharmacological approach is beneficial for some patients, but harmful for others is that ARDS is an extremely heterogeneous syndrome. To overcome this issue, a precision approach for ARDS, whereby therapies are specifically targeted to patients most likely to benefit, has been proposed. At present, however, the application of this approach seems to be a difficult task.

KEYWORDS:

• Acute respiratory distress syndrome
• acute lung injury
• biological targets
• drug therapy
• phenotypes
• precision medicine

Article highlights

• Although numerous pharmacologic therapies have been studied in clinical trials to improve clinical outcomes in ARDS, none has shown real efficacy.

• There is still no definite drug for ARDS that is capable of reducing either short-term or long-term mortality.

• The likely reason why a pharmacological approach is beneficial for some patients, but harmful for others is that ARDS is an extremely heterogeneous syndrome.

• A precision approach for ARDS, whereby therapies are specifically targeted to patients most likely to benefit, has been proposed but identification of homogeneous subgroups or phenotypes in ARDS is not easy.

• The most correct approach is still to use to the best of our knowledge the many available therapeutic possibilities, always hoping to have identified the most responsive tractable trait and, consequently, the right treatment for the right patient.

This box summarizes key points contained in the article.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This manuscript has not been funded.