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Guidelines
Guidelines on the management of acute respiratory distress syndrome
  1. Mark J D Griffiths1,
  2. Danny Francis McAuley2,
  3. Gavin D Perkins3,
  4. Nicholas Barrett4,
  5. Bronagh Blackwood2,
  6. Andrew Boyle2,
  7. Nigel Chee5,
  8. Bronwen Connolly6,
  9. Paul Dark7,
  10. Simon Finney1,
  11. Aemun Salam1,
  12. Jonathan Silversides2,
  13. Nick Tarmey5,
  14. Matt P Wise8 and
  15. Simon V Baudouin9
  1. 1Peri-Operative Medicine, Barts Health NHS Trust, London, UK
  2. 2Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, Belfast, UK
  3. 3Warwick Clinical Trials Unit, University of Warwick, Coventry, West Midlands, UK
  4. 4Critical Care, Saint Thomas' Hospital, London, UK
  5. 5Academic Department of Critical Care, QueenAlexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
  6. 6Respiratory Medicine, King's College London, London, UK
  7. 7Division of Infection,Immunity and Respiratory Medicine,NIHR Biomedical Research Centre, University of Manchester, Manchester, Greater Manchester, UK
  8. 8Intensive Care, Heath Hospital, Cardiff, UK
  9. 9Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to Professor Mark J D Griffiths; mark.griffiths{at}bartshealth.nhs.uk

Abstract

The Faculty of Intensive Care Medicine and Intensive Care Society Guideline Development Group have used GRADE methodology to make the following recommendations for the management of adult patients with acute respiratory distress syndrome (ARDS). The British Thoracic Society supports the recommendations in this guideline. Where mechanical ventilation is required, the use of low tidal volumes (<6 ml/kg ideal body weight) and airway pressures (plateau pressure <30 cmH2O) was recommended. For patients with moderate/severe ARDS (PF ratio<20 kPa), prone positioning was recommended for at least 12 hours per day. By contrast, high frequency oscillation was not recommended and it was suggested that inhaled nitric oxide is not used. The use of a conservative fluid management strategy was suggested for all patients, whereas mechanical ventilation with high positive end-expiratory pressure and the use of the neuromuscular blocking agent cisatracurium for 48 hours was suggested for patients with ARDS with ratio of arterial oxygen partial pressure to fractional inspired oxygen (PF) ratios less than or equal to 27 and 20 kPa, respectively. Extracorporeal membrane oxygenation was suggested as an adjunct to protective mechanical ventilation for patients with very severe ARDS. In the absence of adequate evidence, research recommendations were made for the use of corticosteroids and extracorporeal carbon dioxide removal.

  • ARDS

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjresp-2019-000420

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    Footnotes

    • Contributors Each author contributed elements to the final text.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests Each author contributed elements to the final text.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.