Mechanical Ventilation in Adults with Acute Respiratory Distress Syndrome An Official Clinical Guideline of American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine

Abstract

Adopted from: Fan E., Del Sorbo L., Goligher E.C., Hodgson C.L., Munshi L., Walkey A.J., Adhikari N.K.J., Amato M.B.P., Branson R., Brower R.G., Ferguson N.D., Gajic O., Gattinoni L., Hess D., Mancebo J., Meade M.O., McAuley D.F., Pesenti A., Ranieri V.M., Rubenfeld G.D., Rubin E., Seckel M., Slutsky A.S., Talmor D., Thompson B. T., Wunsch H., Uleryk E., Brozek J., Brochard L.J. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am. J. Respir. Crit. Care Med. 2017; 195 (9): 1253–1263. DOI: 10.1164/rccm.201703-0548STThe aim of this guideline is to provide clinical recommendation on the use of mechanical ventilation in adult patients with acute respiratory distress syndrome (ARDS).Methods. This guideline is based on systematic review and metaanalysis of available literature on the use of mechanical ventilation in adult patients with ARDS.Results. All patients with ARDS should be mechanically ventilated with the use of lower tidal volumes (4–8 ml/kg predicted bodyweight) and lower inspiratory pressures (plateau pressure, 30 cm H2O). In severe ARDS, the prone positioning for more than 12 h/d is strongly recommended. In patients with moderate to severe ARDS, routine use of high-frequency oscillatory ventilation is not recommended; a conditional recommendation has been developed for the use of higher positive end-expiratory pressure and recruitment maneuvers. CuОР – ently, there is not enough evidence for the use of extracorporeal membrane oxygenation in patients with severe ARDS.Conclusions. Practical recommendations on selected methods to coОР – ect ventilation disturbances in adult patients with ARDS have been developed. Clinicians involved in the management of patients with ARDS should use personalized approach to the treatment of these patients.