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Table 4 Summary of therapies for acute respiratory distress syndrome

From: Biomarkers for Acute Respiratory Distress syndrome and prospects for personalised medicine

Supportive therapy Comment
Lung protective ventilation with low tidal volume (4–8 ml/kg predicted body weight) and low inspiratory pressures (plateau pressure < 30 cmH2O) Strong recommendation [75]
Higher level of PEEP§ in patients with moderate or severe ARDS Conditional recommendation [75]
Lung recruitment maneuvers in patients with moderate or severe ARDS Conditional recommendation [75]
Prone positioning for more than 12 h/die in patients with severe ARDS Strong recommendation [75]
HFOV Strong recommendation against the routine use of HFOV [75]
ECMO Rescue therapy for refractory hypoxemia in severe ARDS. No recommendation is made, additional studies are needed [75].
Conservative fluid management strategy It shortened the duration of assisted ventilation in large randomized trial [94, 95]
Pharmacological therapy  
Glucocorticoids Inconclusive results on doses and duration of treatment. May provide some benefit on oxygenation, reduce inflammatory process and ventilation days. They are harmful if started 14 days after ARDS diagnosis [96].
Inhaled nitric oxide (NO) Improves transiently oxygenation. Does not affect mortality. Higher grade of AKI [80].
Neuromuscolar blockade Improve outcomes in patients with moderate to-severe ARDS, ensures patient–ventilator synchrony and reduces the risk of VILI [81]. Higher risk of diaphragm atrophy and ICU acquired weakness. Ongoing trial (NCT02509078).
Mesenchimal stem cells Phase 2a clinical trials to establish safety in ARDS are in progress and two phase 1 trials did not report any serious adverse events [81].
  1. §PEEP positive end-expiratory pressure, ARDS acute respiratory distress syndrome, HFOV high frequency oscillatory ventilation, ECMO extra-corporeal membrane oxygenation, AKI acute kidney injury, VILI ventilator-induced lung injury, ICU intensive care unit