Study sheds light on the practice patterns of aerosol drug therapy in patients with ARDS

A new review led by Associate Professor Sanjay Singhal from Dr. Ram Manohar Lohia Institute of Medical Sciences sheds light on the prevalence and practice patterns of ADT in patients with ARDS. The study was made available online on 05 July 2025 and was published in the Journal of Intensive Medicine.

Aerosol therapy is frequently used in critically ill patients admitted to intensive care units (ICUs) worldwide. Previously published studies have shown that most of these patients do not have chronic respiratory disease, and aerosol drug therapy (ADT) is still used. In general, the use of bronchodilators in critically ill patients, other than those with obstructive airway disease, does not routinely impact outcomes.

However, various preclinical and clinical studies on acute respiratory distress syndrome (ARDS) have suggested a possible role for aerosol therapy in accelerating the resolution of pulmonary edema by enhancing fluid and mucociliary clearance, as well as controlling inflammation. Despite a strong physiological and scientific rationale, randomized controlled clinical trials failed to demonstrate the benefits of aerosol therapy in patients with established ARDS. Despite the scarcity of sound scientific evidence and various consensus recommendations by societies, ADT is still used to manage patients with ARDS.

"This multicentric, prospective observational cohort study (Aero-in-ICU) showed that ADT is frequently used in ARDS, with Bronchodilators being the most commonly prescribed drugs through a jet nebulizer, with half of the aerosol sessions at the optimum position (without the use of any expiratory filter," says Dr. Singhal, the corresponding author.

This study emphasizes the need for standardized protocols and further research to align clinical practice with evidence-based recommendations.