Statins
Because of the putative anti-inflammatory effects, statins have been proposed as adjunctive therapy in influenza (NCT02056340), although large clinical trials in patients in ARDS have not demonstrated clinical benefit [35]. A secondary analysis of data from RCTs using latent class analysis suggested that patients with ARDS may be classified into hyper-inflammatory and hypo-inflammatory subphenotypes, and treatment with simvastatin compared to placebo was associated with improved survival in the hyper-inflammatory but not in the hypo-inflammatory subphenotype [36]. Further studies are needed to examine whether adjunctive pharmacologic interventions would be beneficial in targeted subphenotypes of severe RVI.