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Pharmacotherapy of Acute Lung Injury and the Acute Respiratory Distress Syndrome

Cardiovascular Research Institute and Department of Medicine, University of California San Francisco, magdac72{at}yahoo.com

Michael A. Matthay, MD

Department of Medicine and Anesthesia, University of California San Francisco

Acute lung injury and the acute respiratory distress syndrome are common syndromes with a high mortality rate that affect both medical and surgical patients. Better understanding of the pathophysiology of acute lung injury and the acute respiratory distress syndrome and advances in supportive care and mechanical ventilation have led to improved clinical outcomes since the syndrome was first described in 1967. Although several promising pharmacological therapies, including surfactant, nitric oxide, glucocorticoids and lysofylline, have been studied in patients with acute lung injury and the acute respiratory distress syndrome, none of these pharmacological treatments reduced mortality. This article provides an overview of pharmacological therapies of acute lung injury and the acute respiratory distress syndrome tested in clinical trials and current recommendations for their use as well as a discussion of potential future pharmacological therapies including ß₂-adrenergic agonist therapy, keratinocyte growth factor, and activated protein C.

Key Words: acute lung injury • acute respiratory distress syndrome • pulmonary edema • pharmacologic therapies

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