Clinical practice guideline of acute respiratory distress syndrome

The Korean Society of Critical Care Medicine and the Korean Academy of Tuberculosis and Respiratory Diseases Consensus Group

Research output: Contribution to journalReview article

21 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)214-233
Number of pages20
JournalTuberculosis and Respiratory Diseases
Volume79
Issue number4
DOIs
Publication statusPublished - 2016 Oct 1

Keywords

  • Acute
  • Adult
  • Artificial
  • Mechanical
  • Practice Guideline
  • Respiration
  • Respiratory Distress Syndrome
  • Respiratory Distress Syndrome
  • Ventilators

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

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  • Cite this

    The Korean Society of Critical Care Medicine and the Korean Academy of Tuberculosis and Respiratory Diseases Consensus Group (2016). Clinical practice guideline of acute respiratory distress syndrome. Tuberculosis and Respiratory Diseases, 79(4), 214-233. https://doi.org/10.4046/trd.2016.79.4.214