The Latest in Critical Care, 7/31/23 (Issue #10)
New Practice Guidelines for Diagnosis and Management of Acute Respiratory Distress Syndrome
As mentioned here previously, a group of U.S. and European experts arrived at a consensus of new recommendations for the management of acute respiratory distress syndrome (ARDS), now publishing their guidance in JAMA. The highlights include:
A trial of high-flow nasal cannula oxygen was advised before intubating patients.
Noninvasive ventilation was neither endorsed nor discouraged based on lack of evidence.
Prone positioning for moderate or severe hypoxemia was strongly encouraged, largely based on PROSEVA.
Use of higher PEEP was neither advised nor discouraged, based on lack of evidence.
Recruitment maneuvers were discouraged, based on evidence of harm greater than benefit.
Extracorporeal membrane oxygenation (ECMO) was encouraged, based largely on the EOLIA trial. Referral to ECMO centers was endorsed for patients who “meet criteria” (i.e., severe hypoxemia not doing well or on a bad trajectory wh…
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