Ketoconazole for Early Treatment of Acute Lung Injury and Acute Respiratory Distress Syndrome

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Abstract
The acute respiratory distress syndrome (ARDS) has been recognized for more than 30 years as a severe form of acute respiratory failure. Patients with this disorder are critically ill, require mechanical ventilation in an intensive care unit (ICU), and have a high mortality, ranging from 35% to 50% in recent reports.1,2 Sepsis, severe trauma, aspiration of gastric contents, and massive blood transfusion are the most common clinical events that place patients at risk for the development of ARDS.3 Recently, the concept of ARDS has been expanded to include milder forms of the same pathophysiologic process. The entire pathophysiologic spectrum is now called acute lung injury (ALI), whereas ARDS refers to the more severe end of that spectrum.4 The degree of impairment of oxygenation of arterial blood is used to distinguish patients with ARDS from those with ALI. Despite this distinction, available data suggest the outcomes for patients with ALI are similar to outcomes of the subset of patients with ARDS.5 Supportive care is the current state-of-the-art therapy for ALI and ARDS; no specific pharmacologic therapies have yet proved efficacious.1

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