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February 23, 2016

The Acute Respiratory Distress Syndrome: Dialing in the Evidence?

Author Affiliations
  • 1Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora
JAMA. 2016;315(8):759-761. doi:10.1001/jama.2016.0292

Acute respiratory distress syndrome (ARDS) could be regarded as a prototypical disorder that has benefited from a bench to bedside research approach. After its original description in 1967, the complex pathophysiology of ARDS has been slowly unraveled through extensive basic and translational research. Based on this improved understanding of the mechanisms responsible for ARDS, a variety of major clinical trials were subsequently designed and conducted. Several of these clinical trials identified relatively simple and biologically plausible interventions that reduced mortality for patients with ARDS. For example, the ARDS network trial established that low tidal volume ventilation (6 mL/kg of predicted body weight) reduced mortality from 40% to 31%.1 A meta-analysis of 3 other trials demonstrated that a strategy of high positive end-expository pressure (PEEP) was associated with decreased mortality for patients with moderate to severe ARDS.2 In addition, ventilation in the prone position early in the course of moderate to severe ARDS resulted in a 16% absolute risk reduction in mortality.3 In theory, these beneficial therapies should be relatively easy to implement. They are essentially free, involve adjusting the dials on the ventilator or positioning patients, and are relatively safe.

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