Prevention of acute respiratory distress syndrome

Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) are characterized by rapid-onset respiratory failure after a variety of direct and indirect insults to the parenchyma or vasculature of the lungs. Abundant research has led to improvements in supportive care, but mortality from ALI/ARDS remains substantial. Surprisingly, little research has been done on ALI/ARDS prevention and patients at risk are often studied late into the course of the illness, after admission to intensive care unit. Early detection of at-risk patients is crucial for implementing preventive and therapeutic strategies early in the course. The mechanisms of ALI/ARDS offer an array of possible targets for prevention. Epidemiologic studies suggest a protective role of early treatment of shock and infection, avoidance of tidal hyperventilation, and minimizing plasma transfusion from alloimmunized donors. While systemic steroid administration has a limited role, promising novel pharmacoprevention strategies include antiplatelet agents, systemic and inhaled anticoagulants, inhaled steroids, and systemic administration of antioxidants and HMG-CoA reductase inhibitors. Here, we review recent advances in prevention of ALI/ARDS.