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Open Access 01-12-2019 | Acute Respiratory Distress-Syndrome | Review

Formal guidelines: management of acute respiratory distress syndrome

Authors: Laurent Papazian, Cécile Aubron, Laurent Brochard, Jean-Daniel Chiche, Alain Combes, Didier Dreyfuss, Jean-Marie Forel, Claude Guérin, Samir Jaber, Armand Mekontso-Dessap, Alain Mercat, Jean-Christophe Richard, Damien Roux, Antoine Vieillard-Baron, Henri Faure

Published in: Annals of Intensive Care | Issue 1/2019

Abstract

Fifteen recommendations and a therapeutic algorithm regarding the management of acute respiratory distress syndrome (ARDS) at the early phase in adults are proposed. The Grade of Recommendation Assessment, Development and Evaluation (GRADE) methodology has been followed. Four recommendations (low tidal volume, plateau pressure limitation, no oscillatory ventilation, and prone position) had a high level of proof (GRADE 1 + or 1 −); four (high positive end-expiratory pressure [PEEP] in moderate and severe ARDS, muscle relaxants, recruitment maneuvers, and venovenous extracorporeal membrane oxygenation [ECMO]) a low level of proof (GRADE 2 + or 2 −); seven (surveillance, tidal volume for non ARDS mechanically ventilated patients, tidal volume limitation in the presence of low plateau pressure, PEEP > 5 cmH2O, high PEEP in the absence of deleterious effect, pressure mode allowing spontaneous ventilation after the acute phase, and nitric oxide) corresponded to a level of proof that did not allow use of the GRADE classification and were expert opinions. Lastly, for three aspects of ARDS management (driving pressure, early spontaneous ventilation, and extracorporeal carbon dioxide removal), the experts concluded that no sound recommendation was possible given current knowledge. The recommendations and the therapeutic algorithm were approved by the experts with strong agreement.

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Title: Formal guidelines: management of acute respiratory distress syndrome
Authors: Laurent Papazian
Cécile Aubron
Laurent Brochard
Jean-Daniel Chiche
Alain Combes
Didier Dreyfuss
Jean-Marie Forel
Claude Guérin
Samir Jaber
Armand Mekontso-Dessap
Alain Mercat
Jean-Christophe Richard
Damien Roux
Antoine Vieillard-Baron
Henri Faure
Publication date: 01-12-2019
Publisher: Springer International Publishing
Keywords: Acute Respiratory Distress-Syndrome
ECMO
ECMO
Published in: Annals of Intensive Care / Issue 1/2019
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-019-0540-9

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Formal guidelines: management of acute respiratory distress syndrome

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Keynote webinar | Spotlight on sleep in brain health

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Abstract

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