Effect of aprotinin in adult respiratory distress syndrome

The possible beneficial effect of aprotinin, a broad protease inhibitor, on the incidence and outcome of ARDS was examined in two complementary studies. In the first study, the effect of aprotinin was assessed in 147 patients admitted with multiple trauma or shock. In the 57 patients who developed ARDS, mortality was significantly less in those who had previously received aprotinin (8/20, 40%) than in those who had not (26/37, 70%). Although both treatment groups were well matched, this was a retrospective study and a second prospective, randomised, controlled study was therefore carried out. In 78 patients at risk of ARDS, there was no significant difference between treated and control patients in the incidence, duration or severity of ARDS, or in mortality or other major complications. It is concluded that aprotinin is not effective in improving any aspect of ARDS or its outcome in seriously ill patients.