The impact of aviptadil as an add-on to the standard of care in acute respiratory distress syndrome

<bold>Background:</bold> Before COVID-19, acute respiratory distress syndrome (ARDS) mortality ranged from 40-58%, rising to 80% during the pandemic. Aviptadil (synthetic vasoactive intestinal peptide[VIP]) is designated as an orphan treatment in ARDS. Its anti-inflammatory effects and ability to enhance surfactant production position it as a potential candidate for mitigating lung injury. The imperative of targeted approaches in recent ARDS clinical trials underscores the significance of exploring the role of aviptadil in diverse ARDS etiologies. <bold>Aims and objectives:</bold> To investigate the impact of aviptadil as an add-on treatment to the standard of care (SOC) in patients with various etiologies of ARDS. <bold>Methods:</bold> Patients diagnosed with ARDS between March-December, 2023 were retrospectively analysed (age 50.7±11.3 years) in aviptadil (n=27) and SOC (n=23) groups. Leading lung injury causes were 24% infections, 24% pneumonia, 14% sepsis, and 14% pancreatitis. The oxygenation rate and 28-day survivability were assessed. <bold>Results:</bold> Aviptadil showed a remarkable PaO2/FiO2 increase (Δ135.93), surpassing the SOC (Δ71.61, p = 0.0218). Improvement in PaO2/FiO2 in aviptadil was strongly correlated with CRP reduction (r=-0.5208; p=0.0053) compared to SOC (r=-0.3361; p=0.1169). Aviptadil showed a higher 28-day survival rate than SOC (70.4% vs. 56.5%) though not statistically significant (p=0.309), the odds favoured the addition of aviptadil treatment to the SOC (OR:1.83; 95%CI: 0.57-5.87). <bold>Conclusion:</bold> This research underscores the potential of aviptadil as an adjunct treatment in ARDS management, showing notable improvements in oxygenation and a trend toward enhanced survival. Further, larger studies are needed.