Drugs for treating acute respiratory distress syndrome (ARDS) in critically ill patients.
Citation: Lewis SR, Pritchard MW, Thomas CM, et al. Pharmacological agents for adults with acute respiratory distress syndrome. Cochrane Database of Systematic Reviews 2019; (7): CD004477.
What is this? Some patients with COVID-19 will develop acute respiratory distress syndrome (ARDS) and need help with their breathing. ARDS is caused by direct or indirect injury to the lungs and about 40% of people with ARDS will die. It is usually managed in an intensive care unit (ICU), sometimes with mechanical ventilation, and drugs might be used to help repair lung damage or limit the body’s response to the injury.
In this Cochrane systematic review, the authors searched for randomized trials of drugs to treat adults with established ARDS. They did not restrict by language of publication but excluded studies published before 2000. They did their searches in December 2018. They identified 48 eligible studies (6299 participants) treated with five principal types of agent: corticosteroids, surfactants, N-acetylcysteine, statins and beta-agonists.
What works: Corticosteroids may reduce all-cause mortality within 3 months and increase the number of ventilator-free days up to day 28.
What doesn’t work: Beta-agonists probably slightly increase early mortality.
What’s uncertain: Surfactants, N-aceytylcysteine and statins probably make little or no difference to early mortality. It is uncertain if corticosteroids make any difference to late (later than 3 months) all-cause mortality. The review did not investigate the effects of nitric oxide, inhaled prostacyclins, partial liquid ventilation, neuromuscular blocking agents, fluid and nutritional interventions or medical oxygen.
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