Table 2.

Summary of Pharmacologic Therapies With the Level of Evidence and Recommendations

Intervention	End Points	Highest Level of Evidencea	Recommendation	Grade of Recommendationb
Surfactant: pooled data	Mortality	I	No	A
	Ventilator-free days
Surfactant: protein-free surfactants	Mortality	I	No	B
	Ventilator-free days
Surfactant: protein-containing surfactants	Mortality	I	No	B
	Ventilator-free days
Nitric oxide	Mortality	I	No	A
	Oxygenation		Yesc
Inhaled prostacyclins	Oxygenation	V	Yesc	F
Vasodilators: IV PGE 1	Mortality	II	No	C
	Ventilator-free days
Vasodilators: liposomal IV PGE	Mortality	I	No	B
	Ventilator-free days
High-dose methylprednisolone for prevention of ARDS in patients at risk	Incidence of ARDS	I	No	B
High-dose methylprednisolone for early therapy of ARDS	Mortality	II	No	D
	Severity of lung injury
High-dose methylprednisolone for subacute (late) phase of ARDS	Mortality	I	No	B
	Ventilator-free days
Ketoconazole	Mortality	I	No	B
	Ventilator-free days
Lisofyline	Mortality	I	No	B
	Ventilator-free days
Pentoxifylline	Safety	V	No	F
N-Acetylcysteine	Mortality	II	No	C
	Ventilator-free days
Procysteine	Mortality	II	No	D
	Ventilator-free days

IV – intravenously; PGE 1 – prostaglandin E1; ARDS – acute respiratory distress syndrome.

^aEvidence level:

I: Large randomized controlled trial

II: Small randomized controlled trial

III: Nonrandomized, concurrent controls

IV: Nonrandomized, historical controls

V: Case series reports

Level of evidence definition adapted from Sackett [1]; large randomized trial defined as study of ≥200 patients.

^bGrade of recommendation:

Grade A: Supported by at least 2 level I investigations

Grade B: Supported by at least 1 level I investigations

Grade C: Supported by at least 2 level II investigations

Grade D: Supported by at least 1 level II investigations

Grade E: Supported by at least 1 level III investigations

Grade F: Supported by level IV or level V investigation

Grade of recommendation adapted from the Pulmonary Artery Catheter Consensus Conference [3].

^cSevere ARDS with refractory hypoxemia only.