Key Points
- These recommendations apply only to patients with acute respiratory distress syndrome (ARDS) and do not address questions related to pharmacologic therapies to facilitate mechanical ventilation (e.g., neuromuscular blockade), adjunctive measures (e.g., inhaled vasodilators), and other ventilatory modes (e.g., airway pressure release ventilation).
- Recommendations have not been made for combined or sequential treatments with interventions included in this guideline since their potential benefits or synergies have not been explicitly studied.
Recommendations
- The ATS, ESICM, and SCCM recommend that adult patients with ARDS receive mechanical ventilation with strategies that limit tidal volumes (4–8 ml/kg predicted body weight –PBW) and inspiratory pressures (plateau pressure <30 cm H2O) (Strong recommendation, moderate confidence in effect estimates).
- The ATS, ESICM, and SCCM recommend that adult patients with severe ARDS receive prone positioning for >12 hours per day. (Strong recommendation, moderate-high confidence in effect estimates)
- The ATS, ESICM, and SCCM recommend that high-frequency oscillatory (HFOV) NOT be used routinely in patients with moderate or severe ARDS. (Strong recommendation, moderate-high confidence in effect estimates)
- The ATS, ESICM, and SCCM suggest that adult patients with moderate or severe ARDS receive higher rather than lower levels of positive end-expiratory pressure (PEEP). (Conditional recommendation, moderate confidence in effect estimates)
- The ATS, ESICM, and SCCM suggest that adult patients with moderate or severe ARDS receive recruitment maneuvers (RMs). (Conditional recommendation, low-moderate confidence in the effect estimates)
- Additional evidence is necessary to make a definitive recommendation for or against the use of extracorporeal membrane oxygenation (ECMO) in patients with severe ARDS. In the interim, the ATS, ESICM, and SCCM recommend ongoing research measuring clinical outcomes among patients with severe ARDS who undergo ECMO.
