Management of Acute Respiratory Distress Syndrome in Adults

GUIDELINE TITLE: Mechanical Ventilation in Adult Patients With Acute Respiratory Distress Syndrome

DEVELOPER: American Thoracic Society (ATS)/European Society of Intensive Care Medicine (ESICM)/Society of Critical Care Medicine (SCCM)

RELEASE DATE: May 1, 2017

TARGET POPULATION: Hospitalized adults with acute respiratory distress syndrome (ARDS).

SELECTED MAJOR RECOMMENDATIONS:

For all patients with ARDS:
• Use lower tidal volumes of 4 to 8 mL/kg per breath, calculated using predicted body weight (PBW) (strong recommendation; moderate confidence in effect estimate).
• Use lower inspiratory pressures, targeting a plateau pressure <30 cm H2O (strong recommendation; moderate confidence).

For patients with severe ARDS (PaO2/FIO2 ratio <100):
• Use prone positioning for at least 12h/d (strong recommendation; moderate confidence).
• Do not routinely use high-frequency oscillatory ventilation (strong recommendation; high confidence).
• Additional evidence is needed to recommend for or against the use of extracorporeal membrane oxygenation (ECMO) in severe ARDS.