PHARMACOLOGIC ADJUNCTS TO MECHANICAL VENTILATION IN ACUTE RESPIRATORY DISTRESS SYNDROME

Acute or adult respiratory distress syndrome (ARDS) was first described in the 1960s 7 and was recently reviewed. 101 The medical treatment of this syndrome has been largely directed at ventilatory and general supportive care. The recent slight reduction in the historic 50% mortality rate for ARDS has been attributed to advances in respiratory care. 102 In this article, pharmacologic attempts at mitigating the severity of presentation or preventing the development of ARDS are discussed. Specifically, clinical trials examining the therapeutic effects of ketoconazole, antioxidants, corticosteroids, surfactant, ketanserin, pentoxifylline, bronchodilators, and almitrine on the development or manifestation of ARDS are reviewed. Further aspects of current animal data, basic science, proposed mechanism of actions, and supporting clinical trials are critically reviewed. Pulmonary vasodilators, (i.e., prostacyclin and prostaglandin E 1 ), inhaled nitric oxide, new techniques for ventilation, extracorporeal approaches to the removal of carbon dioxide and the supplementation of oxygen, and techniques in which partial liquid ventilation with perfluorocarbons are used are covered in other articles in this publication.