Adult Respiratory Distress Syndrome: Drug Therapy

Therapeutic Targets

  • Treatment of hypoxia (reduced supply of oxygen to the body).
  • Prevention of further complications

Therapy recommendations

  • Mechanical ventilation/lung protective ventilation (see “Further therapy” below).
    • In particularly severe forms of ARDS, if necessary, with initial neuromuscular blockade with cisatracurium (drug from the group of non-depolarizing muscle relaxants) for 48 hours (→ reduction of 90-day mortality and total duration of ventilation)
  • Fluid restriction
  • Positioning therapy – with the upper body elevated; if necessary, intermittent prone position.
  • Drug therapy
    • Analgesics and sedatives (due tomechanical ventilation).
    • Glucocorticoids (neither low nor high dosage (caveat increased mortality (death rate)) sufficient evidence).
    • Substitution of synthetic, recombinant, or natural surfactant → short-term oxygenation enhancement/improvement of tissue oxygenation (no effect on lethality/mortality rate)
    • Β2-Receptor agonists: neither i.v. application of salbutamol nor for inhalation of albuterol showed a positive efffect.
    • Almitrin vasoconstrictor/vasoconstrictor agents): may improve ventilation-perfusion ratio and thus oxygenation; caveat: risk of lactic acidosis (hyperacidity due to excessively high blood lactate levels) or liver injury.
  • ECMO (extracorporeal membrane oxygenation) for organ recovery (“bridge to recovery”):
    • Weaning (ventilator weaning) of ECMO resp.
    • Bridging to a necessary transplantation (“bridge to transplant”), if no organ regeneration occurs.
  • Treatment of the causative disease
  • See also under sepsis/drug therapy.