ARDS update: Are new therapies improving clinical outcomes? Efforts to target specific processes and potentially decrease mortality

In 30 years, ARDS has become a well-recognized clinical entity. Mortality has exceeded 50%, but some studies suggest a decline, possibly because of improved patient care. New therapies have been investigated in an effort to reduce mortality. These include newer ventilatory strategies, surfactant repletion, anti-inflammatory agents, and antioxidants. New ventilatory strategies are designed to prevent further lung damage by limiting tidal volume and airway pressures. Exogenous surfactant or fluorocarbons may improve oxygenation and lung compliance. Among the anti- inflammatory agents, corticosteroids may be most beneficial when used later in the course of ARDS, when parenchymal fibrosis is most likely to develop. Antioxidants may decrease lipid peroxidation and the resultant increases in vascular permeability and interstitial edema.