What’s evidence based in ARDS?

A review in Cleveland Clinic Journal of Medicine summarizes the latest findings on several modalities. Low tidal volume ventilation (6 ml/kg ideal body weight) is well established. High “recruitment levels” of positive end expiratory pressure (PEEP) are theoretically appealing but do not improve outcomes. Prone positioning, high frequency ventilation, and nitric oxide have failed to live up to initial promise. Conspicuously absent from this article was the mention of corticosteroids for late phase (greater than 7 days) ARDS, recently studied in the ARDSnet Late Steroid Rescue Study. This study has been completed and, after publication date of the CCJM article, was published in NEJM with the conclusion that late phase corticosteroid therapy for ARDS is not beneficial.