ARDS: What's new in management?

Acute respiratory distress syndrome (ARDS) is a major cause of morbidity and mortality in the ICU. Although the overall outcome for severe ARDS has improved over the last decade, the mortality continues to be 40% to 60%. All patients with ARDS experience progressive respiratory insufficiency requiring high concentrations of oxygen and mechanical ventilation. Since no specific therapy exists for ARDS thus far, treatment is mainly supportive. Inhaled nitric oxide, corticosteroids, antioxidants, antiproteases, surfactants, cyclooxygenase, inhibitors, and anticytokine agents have not yet been shown to have significant benefit. If a predisposing factor or underlying condition is identified, direct therapy toward it as early as possible. Ventilatory strategy using low cyclic parenchymal stretch with smaller tidal volumes increases the chances of lung recovery.