Korean J Crit Care Med.  2016 May;31(2):76-100. 10.4266/kjccm.2016.31.2.76.

Clinical Practice Guideline of Acute Respiratory Distress Syndrome

• Cho YJ
• Moon JY
• Shin ES
• Kim JH
• Jung H
• Park SY
• Kim HC
• Sim YS
• Rhee CK
• Lim J
• Lee SJ
• Lee WY
• Lee HJ
• Kwak SH
• Kang EK
• Chung KS
• Choi WI
• The Korean Society of Critical Care Medicine and the Korean Academy of Tuberculosis and Respiratory Diseases Consensus Group

• KMID: 2350915
• DOI: http://doi.org/10.4266/kjccm.2016.31.2.76

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.

Keyword

practice guideline; respiration, artificial; respiratory distress syndrome, acute; respiratory distress syndrome, adult; ventilators, mechanical

MeSH Terms

Extracorporeal Membrane Oxygenation
Humans
Incidence
Lung
Mortality
Nitric Oxide
Positive-Pressure Respiration
Prone Position
Respiration, Artificial
Respiratory Distress Syndrome, Adult*
Steroids
Tidal Volume
Tracheostomy
Ventilation
Ventilators, Mechanical
Nitric Oxide
Steroids

Reference

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