Tags

Type your tag names separated by a space and hit enter

An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome.
Am J Respir Crit Care Med 2017; 195(9):1253-1263AJ

Abstract

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.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Practice Guideline
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28459336

Citation

Fan, Eddy, et al. "An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients With Acute Respiratory Distress Syndrome." American Journal of Respiratory and Critical Care Medicine, vol. 195, no. 9, 2017, pp. 1253-1263.
Fan E, Del Sorbo L, Goligher EC, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2017;195(9):1253-1263.
Fan, E., Del Sorbo, L., Goligher, E. C., Hodgson, C. L., Munshi, L., Walkey, A. J., ... Brochard, L. J. (2017). An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. American Journal of Respiratory and Critical Care Medicine, 195(9), pp. 1253-1263. doi:10.1164/rccm.201703-0548ST.
Fan E, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients With Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2017 05 1;195(9):1253-1263. PubMed PMID: 28459336.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. 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, AU - ,, PY - 2017/5/2/entrez PY - 2017/5/2/pubmed PY - 2017/7/14/medline SP - 1253 EP - 1263 JF - American journal of respiratory and critical care medicine JO - Am. J. Respir. Crit. Care Med. VL - 195 IS - 9 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. SN - 1535-4970 UR - https://www.unboundmedicine.com/medline/citation/28459336/full_citation L2 - http://www.atsjournals.org/doi/full/10.1164/rccm.201703-0548ST?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -