Therapeutic Strategies in Acute Respiratory Distress Syndrome

Acute Respiratory Distress Syndrome (ARDS) represents a life-threatening form of respiratory failure characterised by diffuse alveolar damage, profound hypoxaemia and increased pulmonary vascular permeability. Management has evolved from purely supportive measures to precision-based interventions. Core respiratory strategies include lung-protective ventilation using low tidal volumes, optimised positive end-expiratory pressure and early prone positioning to improve oxygenation and minimise ventilator-induced lung injury. Extracorporeal support, notably veno-venous membrane oxygenation, offers rescue therapy in refractory cases. Fluid management protocols emphasise conservative strategies to reduce pulmonary oedema, while neuromuscular blockade and sedation protocols may attenuate patient–ventilator dyssynchrony. Pharmacological approaches encompass corticosteroids to modulate dysregulated inflammation and novel immunomodulators targeting cytokine cascades. Emerging therapies under investigation include cell-based treatments, such as mesenchymal stromal cells, aimed at restoring alveolar epithelial integrity and enhancing resolution of inflammation. Biomarker-guided and physiologically personalised strategies are gaining traction to identify subphenotypes most likely to benefit from specific interventions. Globally, adoption of these multimodal strategies has reduced mortality, yet variability persists across regions, underscoring the need for harmonised protocols and further trials to refine timing, dosing and patient selection.

Research from Nature Portfolio

A secondary analysis of a large ARDS cohort investigated the effect of systemic corticosteroids on mortality outcomes. Despite initial associations between corticosteroid use and increased mortality in non-survivors, multivariable adjustment revealed no statistically significant impact on survival. Interaction analyses with vasopressor requirements and arterial oxygenation further demonstrated a neutral effect. These findings underscore the complexity of corticosteroid therapy in ARDS and highlight the necessity for stratification by clinical variables to define subgroups that may derive benefit or harm from glucocorticoid administration.

Therapeutic Strategies in Acute Respiratory Distress Syndrome publication trend

The graph below shows the total number of articles in therapeutic strategies in acute respiratory distress syndrome across all publications each year (not limited to Nature Index journals).

Technical terms

Acute Respiratory Distress Syndrome (ARDS): A severe form of respiratory failure with diffuse alveolar damage and refractory hypoxaemia.

Lung-Protective Ventilation: Mechanical ventilation strategy using low tidal volumes to minimise lung injury.

Positive End-Expiratory Pressure (PEEP): The pressure maintained in the lungs at end expiration to prevent alveolar collapse.

Extracorporeal Membrane Oxygenation (ECMO): An external circuit that oxygenates blood and removes carbon dioxide, used in severe respiratory failure.

Efferocytosis: The process by which phagocytic cells clear apoptotic cells, critical for resolution of inflammation.

Glucocorticoids: A class of anti-inflammatory steroids commonly used to modulate immune responses in ARDS.

References

1. Impaired alveolar macrophage 11β-hydroxysteroid dehydrogenase type 1 reductase activity contributes to increased pulmonary inflammation and mortality in sepsis-related ARDS. Frontiers in Immunology (2023).
2. Lomerizine attenuates LPS-induced acute lung injury by inhibiting the macrophage activation through reducing Ca2+ influx. Frontiers in Pharmacology (2023).
3. Efficacy of corticosteroids in patients with acute respiratory distress syndrome: a meta-analysis. Annals of Medicine (2024).
4. The effectiveness of Corticosteroids on mortality in patients with acute respiratory distress syndrome or acute lung injury: a secondary analysis. Scientific Reports (2015).