Thirty years of clinical trials in acute respiratory distress syndrome

Objective: To systematically review clinical trials in acute respiratory di stress syndrome (ARDS), Data Sources: Computerized bibliographic search of published research and c itation review of relevant articles, Study Selection: All clinical trials of therapies for ARDS were reviewed. T herapies that have been compared in prospective, randomized trials were the focus of this analysis, Data Extraction: Data on population, interventions, and outcomes were obtai ned by review, Studies were graded for quality of scientific evidence, Main Results: Lung protective ventilator strategy is supported by improved outcome in a single large, prospective trial and a second smaller trial, Ot her therapies for ARDS, including noninvasive positive pressure ventilation , inverse ratio ventilation, fluid restriction, inhaled nitric oxide, almit rine, prostacyclin, liquid ventilation, surfactant, and immune-modulating t herapies, cannot be recommended at this time, Results of small trials using corticosteroids in late ARDS support the need for confirmatory large clini cal trials, Conclusions:Lung protective ventilator strategy is the first therapy found to improve outcome in ARDS, Trials of prone ventilation and fluid restricti on in ARDS and corticosteroids in late ARDS support the need for large, pro spective, randomized trials.