Acute Respiratory Distress Syndrome (ESICM)

European Society of Intensive Care Medicine

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

August 10, 2023

Clinical practice guidelines on acute respiratory distress syndrome (ARDS) in adults from the European Society of Intensive Care Medicine (ESICM) were published in July 2023 in Intensive Care Medicine.[1]

High-flow nasal oxygen (HFNO), rather than conventional oxygen therapy, is recommended for nonmechanically ventilated patients who have acute hypoxemic respiratory failure (AHRF) that is not caused by cardiogenic pulmonary edema or an acute exacerbation of chronic obstructive pulmonary disease, to reduce the need for intubation.

Continuous positive airway pressure/noninvasive ventilation is suggested for the treatment of patients with AHRF caused by coronavirus disease 2019, as an alternative to HFNO.

Low tidal volume ventilation (4-8 mL/kg of predicted body weight), rather than the higher tidal volume ventilation that has been used in the past to normalize blood gas levels, is recommended for patients with ARDS to lower the risk of mortality.

The prone position is recommended for patients with moderate to severe ARDS (defined as an arterial oxygen partial pressure/fraction of inspired oxygen ratio of less than 150 mm Hg and a positive end-expiratory pressure of 5 cm H2O or higher despite optimal ventilation settings) to lower the risk of mortality.

Extracorporeal membrane oxygenation (ECMO) is recommended for patients with severe ARDS, who should receive treatment at an ECMO center that meets defined standards.

For more information, please go to Acute Respiratory Distress Syndrome (ARDS).


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