Pharmacologic treatment of the adult respiratory distress syndrome.

Adult respiratory distress syndrome is an inflammatory disorder of the lung parenchyma that results in severe respiratory failure. It is associated with sepsis syndrome and multiple organ failure and may be mediated by a variety of substances, several of which have been discussed in this article. Because sepsis syndrome, ARDS, and multiple organ failure are associated with a high mortality rate that has not been reduced significantly by supportive treatment, a rationale exists for therapeutic intervention with agents that affect the inflammatory cascade. Several of these agents, notably corticosteroids and prostaglandin E1, have been shown to be of no benefit in humans despite laboratory and animal studies suggesting their utility. Other agents, including surfactant, antiendotoxin antibodies, and NSAIDs, are undergoing clinical trials and may prove to be effective. A third group, including anti-TNF antibodies and pentoxifylline, are of theoretical benefit but await clinical trials.