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😎 The American Thoracic Society updates its Clinical Practice Guidelines for the management of patients with acute respiratory distress syndrome (ARDS), incorporating new evidence addressing the use of corticosteroids, extracorporeal membrane oxygenation, neuromuscular blockade, and positive end-expiratory pressure (PEEP).

📃The new guidelines suggest:

1) Use of corticosteroids for patients with ARDS (conditional recommendation, moderate certainty of evidence)

2) Indication of veno-venous extracorporeal membrane oxygenation (V-V ECMO) in selected patients with severe ARDS (conditional recommendation, low quality of evidence)

3) Use of neuromuscular blockers in patients with early severe ARDS (conditional recommendation, low quality of evidence)

4) Use of higher PEEP without pulmonary recruitment measures in opposition to lower PEEP in patients with moderate to severe ARDS (conditional recommendation, low to moderate certainty) and

5) Prolonged lung recruitment maneuvers are NOT recommended in patients with moderate to severe ARDS (strong recommendation, moderate certainty).

😏Some previous recommendations were maintained:

6) VT between 4 to 8mL/kg of predicted body weight with a plateau pressure of less than 30cmH2O. (strong recommendation, moderate certainty of evidence).

7)) Prone position >12h/day in patients with severe ARDS (strong recommendation, moderate certainty of evidence).

8) Do not routinely use high-frequency oscillatory ventilation in patients with moderate or severe ARDS (strong recommendation, high certainty of evidence).

The figure below summarizes the essential new recommendations that the article outlined.

🧐 The new guidelines do not address the use of non-invasive respiratory support in ARDS cases, notably high-flow nasal cannula, CPAP, and NIV, as well as the role of interfaces such as the helmets.

🧐 The use of corticosteroids deserves an in-depth discussion regarding the risks and benefits of this therapy.

👉 Follow the link for the article that has free access.

An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline

An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline

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