Preventing ARDS: progress, promise, and pitfalls

Abstract

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. Despite decades of research, there is no proven pharmacologic treatment of ARDS, and mortality from ARDS remains high. Consequently, recent initiatives have broadened the scope of lung injury research to include targeted prevention of ARDS. Prediction scores have been developed to identify patients at risk for ARDS, and clinical trials testing aspirin and inhaled budesonide/formoterol for ARDS prevention are ongoing. Future trials aimed at preventing ARDS face several key challenges. ARDS has not been validated as an end point for pivotal clinical trials, and caution is needed when testing toxic therapies that may prevent ARDS yet potentially increase mortality.

Figures

Figure 1 –

Trends in incidence of community-acquired and nosocomial ARDS from 2001 to 2008 in Olmsted County, Minnesota. Incidence of community-acquired ARDS, defined as fulfilling all diagnostic criteria within 6 h of admission, did not change significantly over time (P = .887). Incidence of nosocomial ARDS, defined as first fulfilling all diagnostic criteria> 48 h after admission, decreased significantly over time (P < .001). Adapted with permission from Li et al.

Figure 2 –

Frequency of ARDS development according to LIPS points. Reproduced with permission from Gajic et al. LIPS = Lung Injury Prediction Score.