COMMENTARY

Does Aspirin Reduce the Risk of Developing Acute Respiratory Distress Syndrome?

Greg Martin, MD

Disclosures

June 03, 2016

Effect of Aspirin on Development of ARDS in At-Risk Patients Presenting to the Emergency Department: The LIPS-A Randomized Clinical Trial

Kor DJ, Carter RE, Park PK, et al; US Critical Illness and Injury Trials Group: Lung Injury Prevention with Aspirin Study Group (USCIITG: LIPS-A)
JAMA. 2016 May 15. [Epub ahead of print]

Summary

Acute respiratory distress syndrome (ARDS) is among the most common and feared respiratory conditions in critically ill patients.[1] ARDS is a form of acute inflammatory lung injury, most often due to sepsis, severe trauma, aspiration, pancreatitis and other systemic injuries, and inflammatory disorders.[2]

Although we do not yet have effective drug therapies for ARDS, much attention has focused on prevention of ARDS. The authors of this study sought to follow up prior observations studies suggesting a role for aspirin in preventing ARDS,[3,4,5] to determine whether aspirin may prevent the development of ARDS if given early in patients at moderate to high risk.[6]

In the study, 400 emergency department patients at risk for ARDS (Lung Injury Prediction Score ≥ 4) were randomly assigned to receive treatment with aspirin (325 mg initial dose and 81 mg daily for 7 days) or placebo.[7] ARDS developed in 10.3% of patients receiving aspiring and 8.7% of those receiving placebo (P=.53), and there were no differences between groups in terms of mortality or length of stay in the hospital or intensive care unit. The authors concluded that aspirin is ineffective for preventing ARDS.

Viewpoint

The difficulty in treating ARDS has led to increased interest in prevention as a more effective strategy. Although this is appealing and clinically important, the same challenges that have led to failed ARDS trials (heterogeneous causes of ARDS, sufficient understanding of disease pathogenesis, and other factors) is equally problematic for studies of prevention.

In this case, there was a growing body of literature about the role of platelets in ARDS and the association between aspirin therapy and either lower rates of ARDS or improved outcomes.[3,4,5] It was reasonable to pursue the possibility that something as simple as aspirin could prevent this severe, life-threatening condition. Unfortunately, aspirin therapy neither prevented ARDS nor demonstrated efficacy for any other measurable outcome, aside from a change in interleukin 2 values at day 1.

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