Drugs for treating acute respiratory distress syndrome (ARDS) in critically ill patients.

Added March 16, 2020

Citation: Lewis SR, Pritchard MW, Thomas CM, et al. Pharmacological agents for adults with acute respiratory distress syndrome. Cochrane Database of Systematic Reviews 2019; (7): CD004477.

What is this? Some patients with COVID-19 will develop acute respiratory distress syndrome (ARDS) and need help with their breathing. ARDS is caused by direct or indirect injury to the lungs and about 40% of people with ARDS will die. It is usually managed in an intensive care unit (ICU), sometimes with mechanical ventilation, and drugs might be used to help repair lung damage or limit the body’s response to the injury.

In this Cochrane systematic review, the authors searched for randomized trials of drugs to treat adults with established ARDS. They did not restrict by language of publication but excluded studies published before 2000. They did their searches in December 2018. They identified 48 eligible studies (6299 participants) treated with five principal types of agent: corticosteroids, surfactants, N-acetylcysteine, statins and beta-agonists.

What works: Corticosteroids may reduce all-cause mortality within 3 months and increase the number of ventilator-free days up to day 28.

What doesn’t work: Beta-agonists probably slightly increase early mortality.

What’s uncertain: Surfactants, N-aceytylcysteine and statins probably make little or no difference to early mortality. It is uncertain if corticosteroids make any difference to late (later than 3 months) all-cause mortality. The review did not investigate the effects of nitric oxide, inhaled prostacyclins, partial liquid ventilation, neuromuscular blocking agents, fluid and nutritional interventions or medical oxygen.

 

Disclaimer: This summary has been written by staff and volunteers of Evidence Aid in order to make the content of the original document accessible to decision makers who are searching for the available evidence on the coronavirus (COVID-19) but may not have the time, initially, to read the original report in full. This summary is not intended as a substitute for the medical advice of physicians, other health workers, professional associations, guideline developers, or national governments and international agencies. If readers of this summary think that the evidence that is presented within it is relevant to their decision-making they should refer to the content and details of the original article, and the advice and guidelines offered by other sources of expertise, before making decisions. Evidence Aid cannot be held responsible for any decisions made about the coronavirus (COVID-19) on the basis of this summary alone.

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