Acute respiratory distress syndrome (ARDS) is a common cause of respiratory failure in medical and surgical ICUs, totaling an estimated 200 000 cases per year in the United States. Despite improved supportive care, the mortality associated with ARDS remains high (30% to 40%). ARDS results from a variety of direct or indirect insults, including sepsis, aspiration, and trauma, all of which lead to pulmonary endothelial and epithelial injury. Several recent trials have led to improvements in the care of patients with ARDS, including the use of a fluid conservative treatment strategy and the use of neuromuscular blockade for severe ARDS. Patients with refractory hypoxemia due to ARDS may benefit from advanced therapies, including inhaled nitric oxide and extracorporeal life support; however, evidence from large clinical trials is lacking. Currently, clinical trials are underway for the treatment of ARDS with statins and inhaled heparin and preclinical evidence is promising for adoptive cellular therapy with mesenchymal stem cells.
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