Decades after initial reports of pathology and treatment, there remains little known about late ARDS. Is late or "fibroproliferative" ARDS truly its own entity, with unique physiology, ideal treatment, and distinctive outcomes? If so, how is late ARDS defined, what is its incidence, and how are these patients best managed to improve both early and late outcomes? Population-based epidemiologic studies, longitudinal cohort studies of survivors, and additional interventional studies that include both short- and long-term outcomes are all needed to answer these questions. Based on current knowledge, there are no specific therapies that have been proven to improve mortality or other patient-centered outcomes of persistent ARDS. The best available evidence does not support corticosteroid treatment of persistent ARDS at this time; however, it remains possible that additional research may discover a protocol and patient population in which the physiological responses seen with corticosteroid therapy translate to true clinical improvement. In the meantime, optimal therapy for late ARDS involves providing the same high-quality critical care that we strive to provide for all patients with acute lung injury, recognizing that prolonged respiratory failure does not connote an increased mortality, and supporting survivors and their families through protracted convalescence and recovery.
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine