TY - JOUR
T1 - An official American Thoracic Society/European Society of intensive care medicine/society of critical care medicine clinical practice guideline
T2 - Mechanical ventilation in adult patients with acute respiratory distress syndrome
AU - Society of Critical Care Medicine
AU - American Thoracic Society
AU - European Society of Intensive Care Medicine
AU - Fan, Eddy
AU - Del Sorbo, Lorenzo
AU - Goligher, Ewan C.
AU - Hodgson, Carol L.
AU - Munshi, Laveena
AU - Walkey, Allan J.
AU - Adhikari, Neill K.J.
AU - Amato, Marcelo B.P.
AU - Branson, Richard
AU - Brower, Roy G.
AU - Ferguson, Niall D.
AU - Gajic, Ognjen
AU - Gattinoni, Luciano
AU - Hess, Dean
AU - Mancebo, Jordi
AU - Meade, Maureen O.
AU - McAuley, Daniel F.
AU - Pesenti, Antonio
AU - Ranieri, V. Marco
AU - Rubenfeld, Gordon D.
AU - Rubin, Eileen
AU - Seckel, Maureen
AU - Slutsky, Arthur S.
AU - Talmor, Daniel
AU - Thompson, B. Taylor
AU - Wunsch, Hannah
AU - Uleryk, Elizabeth
AU - Brozek, Jan
AU - Brochard, Laurent J.
N1 - Publisher Copyright:
Copyright © 2017 by the American Thoracic Society.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Background: This document provides evidence-based clinical practice guidelines on the use of mechanical ventilation in adult patients with acute respiratory distress syndrome (ARDS). Methods: A multidisciplinary panel conducted systematic reviews and metaanalyses of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations. Results: For all patients with ARDS, the recommendation is strong for mechanical ventilation using lower tidal volumes (4-8 ml/kg predicted body weight) and lower inspiratory pressures (plateau pressure < 30 cm H2O) (moderate confidence in effect estimates). For patients with severe ARDS, the recommendation is strong for prone positioning for more than 12 h/d (moderate confidence in effect estimates). For patients with moderate or severe ARDS, the recommendation is strong against routine use of high-frequency oscillatory ventilation (high confidence in effect estimates) and conditional for higher positive end-expiratory pressure (moderate confidence in effect estimates) and recruitment maneuvers (low confidence in effect estimates). Additional evidence is necessary to make a definitive recommendation for or against the use of extracorporeal membrane oxygenation in patients with severe ARDS. Conclusions: The panel formulated and provided the rationale for recommendations on selected ventilatory interventions for adult patients with ARDS. Clinicians managing patients with ARDS should personalize decisions for their patients, particularly regarding the conditional recommendations in this guideline.
AB - Background: This document provides evidence-based clinical practice guidelines on the use of mechanical ventilation in adult patients with acute respiratory distress syndrome (ARDS). Methods: A multidisciplinary panel conducted systematic reviews and metaanalyses of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations. Results: For all patients with ARDS, the recommendation is strong for mechanical ventilation using lower tidal volumes (4-8 ml/kg predicted body weight) and lower inspiratory pressures (plateau pressure < 30 cm H2O) (moderate confidence in effect estimates). For patients with severe ARDS, the recommendation is strong for prone positioning for more than 12 h/d (moderate confidence in effect estimates). For patients with moderate or severe ARDS, the recommendation is strong against routine use of high-frequency oscillatory ventilation (high confidence in effect estimates) and conditional for higher positive end-expiratory pressure (moderate confidence in effect estimates) and recruitment maneuvers (low confidence in effect estimates). Additional evidence is necessary to make a definitive recommendation for or against the use of extracorporeal membrane oxygenation in patients with severe ARDS. Conclusions: The panel formulated and provided the rationale for recommendations on selected ventilatory interventions for adult patients with ARDS. Clinicians managing patients with ARDS should personalize decisions for their patients, particularly regarding the conditional recommendations in this guideline.
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U2 - 10.1164/rccm.201703-0548ST
DO - 10.1164/rccm.201703-0548ST
M3 - Article
C2 - 28459336
AN - SCOPUS:85018943101
SN - 1073-449X
VL - 195
SP - 1253
EP - 1263
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 9
ER -