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ARDS is characterised by an overwhelming inflammatory process [102]. Paediatric data on the effectiveness of steroids is limited to the case series, including the use of methylprednisolone (initial loading dose 5 mg/kg and subsequent maintenance therapy for 2 weeks of 2 mg/kg every 6 h) in a 12-month-old infant with late ARDS, and a case series of six children treated with high-dose steroids [60, 65, 68, 101]. To date, no RCTs have been performed investigating the efficacy of glucocorticoids in PARDS. The role of glucocorticoids as therapy for PARDS remains to be determined. Studies performed in adults with ARDS also fail to provide a clear answer. In fact, two systematic reviews of published adult data reported conflicting results [115, 137].

Other Pharmacological Therapies

Inhaled prostaglandin I2, a natural pulmonary vasodilator, may be considered in a similar manner as iNO [35, 71, 113]. Dahlem observed a significant median improvement of 26% in the OI following nebulisation of 30 ng/kg/min epopros- tenol, but the effect on patient outcome remains unknown [35]. To date, the effect of inhaled beta-adrenergic receptor agonists as the current adult evidence discourages the use of p2-agonist among ARDS patients, heliox, N-acetylcysteine or other drugs such as of ipratropium bromide, dornase alpha outside the cystic fibrosis population, plasminogen activators, fibrinolytics or other anticoagulants on patient outcome that remains to be established [2, 107, 130, 154].

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