Management of Adult Patients with Acute Respiratory Distress Syndrome

Publication Date: November 29, 2023
Last Updated: December 19, 2023

Treatment

New Recommendations in This Guideline

We suggest using corticosteroids for patients with ARDS. (Moderate, Conditional Recommendation)
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We suggest using venovenous extracorporeal membrane oxygenation in selected patients with severe ARDS. (Low, Conditional Recommendation)
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We suggest using neuromuscular blockers in patients with early severe ARDS. (Low, Conditional Recommendation)
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With regard to positive end-expiratory pressure (PEEP):
We suggest using higher PEEP without lung recruitment maneuvers as compared to lower PEEP in patients with moderate-severe ARDS. (Low, Conditional Recommendation)
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We recommend against using prolonged lung recruitment maneuvers in patients with moderate-severe ARDS. (Moderate, Strong Recommendation)
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Recommendations From the 2017 Guideline That Remain in Place

We recommend using mechanical ventilation strategies that limit tidal volume (4–8 ml/kg predicted body weight) and inspiratory pressures (plateau pressure <30 cm H2O) in patients with ARDS. (Moderate, Strong Recommendation)
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We recommend prone positioning for >12 hours per day in patients with severe ARDS. (Moderate, Strong Recommendation)
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We recommend against the routine use of high-frequency oscillatory ventilation in patients with moderate or severe ARDS. (High, Strong Recommendation)
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Recommendation Grading

Abbreviations

  • ARDS: Acute Respiratory Distress Syndrome
  • LRMs: Lung Recruitment Maneuvers
  • NMBAs: Neuromuscular Blocking Agents
  • PEEP: Positive End-expiratory Pressure
  • VV-ECMO: Venovenous Extracorporeal Membrane Oxygenation

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Management of Adult Patients with Acute Respiratory Distress Syndrome

Authoring Organization

Publication Month/Year

November 29, 2023

Last Updated Month/Year

February 15, 2024

Supplemental Implementation Tools

Document Type

Guideline

Country of Publication

US

Document Objectives

This guideline updates and adds torecommendations for the management ofpatients with acute respiratory distresssyndrome (ARDS)

Target Patient Population

Adult Patients with Acute Respiratory Distress Syndrome

Target Provider Population

Pulmonologists, critical care specialists, anesthesiologists, and other allied providers caring for adults patients with ARDS

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Emergency care, Hospital, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant, respiratory therapist

Scope

Treatment, Management

Diseases/Conditions (MeSH)

D012128 - Respiratory Distress Syndrome, Adult, D015199 - Extracorporeal Membrane Oxygenation

Keywords

acute respiratory distress syndrome, positive end-expiratory pressure, ARDS, neuromuscular blockade, extracorporeal membrane oxygenation

Source Citation

Qadir N, Sahetya S, Munshi L, et al. An update on management of adult patients with acute respiratory distress syndrome: an official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. [online ahead of print] 30 Nov 2023; DOI:10.1164/rccm.202311-2011S

Supplemental Methodology Resources

Data Supplement