Clinical Practice Guideline of Acute Respiratory Distress Syndrome

Abstract

There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

Protective effects of the suppressed NF‐κB/TLR4 signaling pathway on oxidative stress of lung tissue in rat with acute lung injury

“…Currently, the only method of treatment for lung diseases is the use of lung protective ventilation with positive end‐expiratory pressure and low tidal volumes, as there is insufficiency in pharmacological therapies for preventing injury or promoting repair . Although there have been a number of therapeutic interventions recognized over the past couple of years, the occurrence of ALI cases has increased from approximately 1.5 to 75 cases per a 100 000 population, while the mortality of patients diagnosed with ARDS has reached 40% . Based on this information, urgency in in discovering newer and more accurate biomarkers is imminent in order to help provide a better diagnosis along with a positive prognosis of ALI.…”

Prolonged Glucocorticoid Treatment in ARDS: Impact on Intensive Care Unit-Acquired Weakness

“…Recent guidelines ( 25 , 26 ) and reviews ( 27 ) have provided an incomplete representation of the available evidence on glucocorticoid treatment in ARDS by citing imprecise meta-analysis ( 28 ) or contradictory results among meta-analyses ( 28 , 29 ). This is having significant repercussions for the care of patients with ARDS and necessitates a clarification.…”

Topical respiratory strategies in neurocritical care

“…Однако, если у нейрореанимационного пациента все же развился РДС, то это существенно утяжеляет состояние пациента и ухудшает исход [54]. Исследования, посвященные РДС, проведенные в популяции общереанимационных пациентов, показали, что исходы заболевания достоверно улучшают следующие терапевтические опции: 1) протективная ИВЛ; 2) прон-позиция; 3) использование мышечных релаксантов [55]. Вместе с этим есть достаточно агрессивные пути коррекции гипоксемии, которые не доказали своей эффективности, но тем не менее применяются при тяжелом РДС: 1) высокочастотная ИВЛ (ВЧ ИВЛ); 2) ингаляции оксида азота [56].…”