TY - JOUR
T1 - An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome
T2 - An Official American Thoracic Society Clinical Practice Guideline
AU - Qadir, Nida
AU - Sahetya, Sarina
AU - Munshi, Laveena
AU - Summers, Charlotte
AU - Abrams, Darryl
AU - Beitler, Jeremy
AU - Bellani, Giacomo
AU - Brower, Roy G.
AU - Burry, Lisa
AU - Chen, Jen Ting
AU - Hodgson, Carol
AU - Hough, Catherine L.
AU - Lamontagne, Francois
AU - Law, Anica
AU - Papazian, Laurent
AU - Pham, Tai
AU - Rubin, Eileen
AU - Siuba, Matthew
AU - Telias, Irene
AU - Patolia, Setu
AU - Chaudhuri, Dipayan
AU - Walkey, Allan
AU - Rochwerg, Bram
AU - Fan, Eddy
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Background: This document updates previously published Clinical Practice Guidelines for the management of patients with acute respiratory distress syndrome (ARDS), incorporating new evidence addressing the use of corticosteroids, venovenous extracorporeal membrane oxygenation, neuromuscular blocking agents, and positive end-expiratory pressure (PEEP). Methods: We summarized evidence addressing four "PICO questions" (patient, intervention, comparison, and outcome). A multidisciplinary panel with expertise in ARDS used the Grading of Recommendations, Assessment, Development, and Evaluation framework to develop clinical recommendations. Results: We suggest the use of: 1) corticosteroids for patients with ARDS (conditional recommendation, moderate certainty of evidence), 2) venovenous extracorporeal membrane oxygenation in selected patients with severe ARDS (conditional recommendation, low certainty of evidence), 3) neuromuscular blockers in patients with early severe ARDS (conditional recommendation, low certainty of evidence), and 4) higher PEEP without lung recruitment maneuvers as opposed to lower PEEP in patients with moderate to severe ARDS (conditional recommendation, low to moderate certainty), and 5) we recommend against using prolonged lung recruitment maneuvers in patients with moderate to severe ARDS (strong recommendation, moderate certainty). Conclusions: We provide updated evidence-based recommendations for the management of ARDS. Individual patient and illness characteristics should be factored into clinical decision making and implementation of these recommendations while additional evidence is generated from much-needed clinical trials.
AB - Background: This document updates previously published Clinical Practice Guidelines for the management of patients with acute respiratory distress syndrome (ARDS), incorporating new evidence addressing the use of corticosteroids, venovenous extracorporeal membrane oxygenation, neuromuscular blocking agents, and positive end-expiratory pressure (PEEP). Methods: We summarized evidence addressing four "PICO questions" (patient, intervention, comparison, and outcome). A multidisciplinary panel with expertise in ARDS used the Grading of Recommendations, Assessment, Development, and Evaluation framework to develop clinical recommendations. Results: We suggest the use of: 1) corticosteroids for patients with ARDS (conditional recommendation, moderate certainty of evidence), 2) venovenous extracorporeal membrane oxygenation in selected patients with severe ARDS (conditional recommendation, low certainty of evidence), 3) neuromuscular blockers in patients with early severe ARDS (conditional recommendation, low certainty of evidence), and 4) higher PEEP without lung recruitment maneuvers as opposed to lower PEEP in patients with moderate to severe ARDS (conditional recommendation, low to moderate certainty), and 5) we recommend against using prolonged lung recruitment maneuvers in patients with moderate to severe ARDS (strong recommendation, moderate certainty). Conclusions: We provide updated evidence-based recommendations for the management of ARDS. Individual patient and illness characteristics should be factored into clinical decision making and implementation of these recommendations while additional evidence is generated from much-needed clinical trials.
KW - acute respiratory distress syndrome
KW - corticosteroids
KW - extracorporeal membrane oxygenation
KW - neuromuscular blockade
KW - positive end-expiratory pressure
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U2 - 10.1164/rccm.202311-2011ST
DO - 10.1164/rccm.202311-2011ST
M3 - Article
C2 - 38032683
AN - SCOPUS:85180943593
SN - 1073-449X
VL - 209
SP - 24
EP - 36
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 1
ER -