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Contemporary Reviews in Critical Care Medicine |

Preventing ARDSARDS Prevention: Progress, Promise, and Pitfalls

Jeremy R. Beitler, MD; David A. Schoenfeld, PhD; B. Taylor Thompson, MD
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Beitler), Brigham and Women’s Hospital; and Biostatistics Center (Dr Schoenfeld) and Pulmonary and Critical Care Unit (Dr Thompson), Department of Medicine, Massachusetts General Hospital, Boston, MA.

CORRESPONDENCE TO: B. Taylor Thompson, MD, Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Bulfinch 148, Boston, MA 02114; e-mail: tthompson1@partners.org


FUNDING/SUPPORT: This work was funded in part by National Institutes of Health [Grants 5-R01-HL60710-9, 1-P01-HL108801, and 5-T32-HL007633].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(4):1102-1113. doi:10.1378/chest.14-0555
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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.

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