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01-12-2020 | Care | Narrative Review

Current and evolving standards of care for patients with ARDS

Authors: Mario Menk, Elisa Estenssoro, Sarina K. Sahetya, Ary Serpa Neto, Pratik Sinha, Arthur S. Slutsky, Charlotte Summers, Takeshi Yoshida, Thomas Bein, Niall D. Ferguson

Published in: Intensive Care Medicine | Issue 12/2020

Abstract

Care for patients with acute respiratory distress syndrome (ARDS) has changed considerably over the 50 years since its original description. Indeed, standards of care continue to evolve as does how this clinical entity is defined and how patients are grouped and treated in clinical practice. In this narrative review we discuss current standards – treatments that have a solid evidence base and are well established as targets for usual care – and also evolving standards – treatments that have promise and may become widely adopted in the future. We focus on three broad domains of ventilatory management, ventilation adjuncts, and pharmacotherapy. Current standards for ventilatory management include limitation of tidal volume and airway pressure and standard approaches to setting PEEP, while evolving standards might focus on limitation of driving pressure or mechanical power, individual titration of PEEP, and monitoring efforts during spontaneous breathing. Current standards in ventilation adjuncts include prone positioning in moderate-severe ARDS and veno-venous extracorporeal life support after prone positioning in patients with severe hypoxemia or who are difficult to ventilate. Pharmacotherapy current standards include corticosteroids for patients with ARDS due to COVID-19 and employing a conservative fluid strategy for patients not in shock; evolving standards may include steroids for ARDS not related to COVID-19, or specific biological agents being tested in appropriate sub-phenotypes of ARDS. While much progress has been made, certainly significant work remains to be done and we look forward to these future developments.

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Title: Current and evolving standards of care for patients with ARDS
Authors: Mario Menk
Elisa Estenssoro
Sarina K. Sahetya
Ary Serpa Neto
Pratik Sinha
Arthur S. Slutsky
Charlotte Summers
Takeshi Yoshida
Thomas Bein
Niall D. Ferguson
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: Care
Hypoxemia
Acute Respiratory Distress-Syndrome
COVID-19
ECMO
ECMO
Published in: Intensive Care Medicine / Issue 12/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06299-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Current and evolving standards of care for patients with ARDS

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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