The FICM/ICS 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 < 20kPa), prone positioning was recommended for at least 12 hours per day.
By contrast, high frequency oscillation is not recommended and it is 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 (PEEP) and the use of the neuro-muscular blocking agent cisatracurium for 48 hours was suggested for ARDS patients with PF ratios less than or equal to 27 and 20 kPa respectively.
Extra-corporeal membrane oxygenation (ECMO) 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 extra-corporeal carbon dioxide removal (ECCOR).
