Update in ARDS management: Recent randomized controlled trials that changed our practice

ABSTRACTIn the last 7 years, 14 randomized controlled trials in patients with acute respiratory distress syndrome (ARDS) have shown that:

• Mechanical ventilation with a tidal volume of 6 mL/kg of predicted body weight is better than mechanical ventilation with a tidal volume of 12 mL/kg of predicted body weight.
• Prone positioning improves oxygenation but poses safety concerns.
• A high level of positive end-expiratory pressure does not improve survival.
• High-frequency oscillatory ventilation is in theory the ideal "lung-protective" method, but its benefits have not been proven.
• No drug therapy has been shown to improve survival in patients with ARDS.
• Exogenous surfactant may improve oxygenation but has no significant effect on the death rate or length of use of mechanical ventilation.
• Low-dose inhaled nitric oxide has no substantial impact on the duration of ventilatory support or on the death rate.
• Partial liquid ventilation may be beneficial in young patients with acute lung injury or ARDS, although further study is needed to confirm this.