Clinical Practice Guideline of Acute Respiratory Distress Syndrome

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 ARD...

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Published inTuberculosis and respiratory diseases Vol. 79; no. 4; pp. 214 - 233
Main Authors Cho, Young-Jae, Moon, Jae Young, Shin, Ein-Soon, Kim, Je Hyeong, Jung, Hoon, Park, So Young, Kim, Ho Cheol, Sim, Yun Su, Rhee, Chin Kook, Lim, Jaemin, Lee, Seok Jeong, Lee, Won-Yeon, Lee, Hyun Jeong, Kwak, Sang Hyun, Kang, Eun Kyeong, Chung, Kyung Soo, Choi, Won-Il
Format Journal Article
LanguageEnglish
Published Korea (South) The Korean Academy of Tuberculosis and Respiratory Diseases 01.10.2016
대한결핵및호흡기학회
Subjects
Review
내과학
Ventilators, Mechanical
Respiratory Distress Syndrome, Adult
Respiration, Artificial
Respiratory Distress Syndrome, Acute
Practice Guideline
Online AccessGet full text
ISSN1738-3536
2005-6184
DOI10.4046/trd.2016.79.4.214

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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.
AbstractList 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.
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 endexpiratory 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. KCI Citation Count: 2
Author Moon, Jae Young
Jung, Hoon
Kwak, Sang Hyun
Chung, Kyung Soo
Kim, Je Hyeong
Lee, Seok Jeong
Lim, Jaemin
Kang, Eun Kyeong
Shin, Ein-Soon
Park, So Young
Lee, Won-Yeon
Kim, Ho Cheol
Cho, Young-Jae
Sim, Yun Su
Choi, Won-Il
Lee, Hyun Jeong
Rhee, Chin Kook
AuthorAffiliation 13 Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea
10 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
3 Research Agency for Clinical Practice Guidelines, Korean Academy of Medical Sciences Research Center, Seoul, Korea
4 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
11 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Kor
AuthorAffiliation_xml – name: 4 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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Issue 4
Keywords Ventilators, Mechanical
Respiratory Distress Syndrome, Adult
Respiration, Artificial
Respiratory Distress Syndrome, Acute
Practice Guideline
Language English
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Young-Jae Cho and Jae Young Moon contributed equally to this work.
G704-000421.2016.79.4.007
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28119754 - Tuberc Respir Dis (Seoul). 2017 Jan;80(1):95
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Snippet There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong...
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Title Clinical Practice Guideline of Acute Respiratory Distress Syndrome
URI https://www.ncbi.nlm.nih.gov/pubmed/27790273
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https://pubmed.ncbi.nlm.nih.gov/PMC5077725
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