Intravenous Aviptadil as Adjunctive Therapy in Severe Acute Respiratory Distress Syndrome: A Case Series of Three Distinct Clinical Scenarios

A 65-year-old female with a background of people living with human immunodeficiency virus (PLHIV) and uncontrolled diabetes mellitus was admitted with progressive dyspnea, fever, and severe hypoxemia.She was diagnosed with severe ARDS likely secondary to opportunistic infection (suspected Pneumocystis jirovecii pneumonia).Initial management included ART optimization, antifungal therapy, and standard ARDS supportive measures. IntroductIonAviptadil, a synthetic analog of vasoactive intestinal peptide (VIP), has recently emerged as a potential adjunctive treatment in severe acute respiratory distress syndrome (ARDS), particularly due to its anti-inflammatory, cytoprotective, and pulmonary vasodilatory properties.1,2 We present a brief case series of three critically ill patients with severe ARDS of differing etiologies, managed in a tertiary intensive care unit, who received intravenous aviptadil along with standard care. case descrIptIon Case 1A 71-year-old previously healthy female presented with acute-onset respiratory distress, hypoxemia, and fever.On admission, she was diagnosed with severe ARDS (PaO₂/FiO₂ < 100), with bilateral lung infiltrates on chest radiograph and elevated inflammatory markers.Despite management with high-flow oxygen, NIV, corticosteroids, and prone positioning, hypoxemia remained refractory.Aviptadil was administered as an intravenous infusion within 12 hours of ICU admission.A significant clinical improvement was observed toward the end of the second day of infusion.PaO₂/ FiO₂ improved from 89 to >250, and SpO₂ improved from 86 to 94%.Serial chest radiographs showed radiological clearance.The patient was successfully weaned off respiratory support and discharged on day 10 postadmission without complications (Fig. 1).