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Review
. 2024 Dec;45(4):885-894.
doi: 10.1016/j.ccm.2024.08.011. Epub 2024 Sep 10.

Steroids and Immunomodulatory Therapies for Acute Respiratory Distress Syndrome

Jonathan E Millar  1 , Thomas H Craven  2 , Manu Shankar-Hari  3
Affiliations
Review

Steroids and Immunomodulatory Therapies for Acute Respiratory Distress Syndrome

Jonathan E Millar et al. Clin Chest Med. 2024 Dec.

Abstract

Acute respiratory distress syndrome (ARDS) is characterized by a dysregulated immune response to infection or injury. This framework has driven long-standing interest in immunomodulatory therapies as treatments for ARDS. In this narrative review, we first define what constitutes a dysregulated immune response in ARDS. In this context, we describe the rationale and available evidence for immunomodulatory therapies studied in randomized controlled trials of ARDS patients to date. Finally, we address factors that have contributed to the failure to develop therapies in the past and highlight current and future developments designed to address them.

Keywords: Acute respiratory distress syndrome; Corticosteroids; Host response; Immunomodulation.

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Conflict of interest statement

Disclosure J E. Millar has no conflicts to disclose. T H. Craven has no conflicts to disclose. M Shankar-Hari is Chief Investigator of trial of GuARDS trial (https://www.isrctn.com/ISRCTN15076735). M Shankar-Hari was supported by the National Institute for Health Research Clinician Scientist Award (CS-2016–16–011; 2017–2023). M Shankar-Hari reported receiving grants from the Chief Scientist Office Scotland, the National Institute for Health and Care Research, United Kingdom (Efficacy and Mechanism Evaluation and Health Technology Assessment programs), the UK Medical Research Council, United Kingdom, Canadian Institute For Health Research, and the Huo Foundation. M Shankar-Hari highlights industry support for TRAITS Research Programme (a Chief Scientists Office, Scotland) funded time critical precision medicine in adult critically ill patients (TRAITS Program) https://traits-trial.ed.ac.uk. The views expressed in this publication are those of the author(s) and not necessarily those of the National Health Service (NHS), the National Institute for Health Research or the Department of Health and social care.

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