Formal guidelines: management of acute respiratory distress syndrome

doi:10.1186/s13613-019-0540-9

Review

. 2019 Jun 13;9(1):69.

doi: 10.1186/s13613-019-0540-9.

Formal guidelines: management of acute respiratory distress syndrome

Affiliations

¹ Service de Médecine Intensive - Réanimation, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France. Laurent.PAPAZIAN@ap-hm.fr.
² Medical Intensive Care Unit, Centre Hospitalier Régional et Universitaire de Brest, site La Cavale Blanche, Bvd Tanguy Prigent, 29609, Brest Cedex, France.
³ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
⁴ Service de Médecine Intensive - Réanimation, Hôpital Cochin, Hôpitaux Universitaires Paris-Centre, Assistance Publique - Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
⁵ Service de Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié- Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47, boulevard de l'Hôpital, 75013, Paris, France.
⁶ Intensive Care Unit, Louis Mourier Hospital, AP-HP, 178 Rue des Renouillers, 92700, Colombes, France.
⁷ Service de Médecine Intensive - Réanimation, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France.
⁸ Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
⁹ Department of Anesthesiology and Intensive Care (DAR B), Saint Eloi University Hospital, Montpellier, France.
¹⁰ Service de Réanimation Médicale, Hôpitaux Universitaires Henri-Mondor, AP-HP, DHU A-TVB, 94010, Créteil, France.
¹¹ Medical Intensive Care Department, Angers University Hospital, 4, rue Larrey, 49933, Angers Cedex, France.
¹² Emergency Department, General Hospital of Annecy, Annecy, France.
¹³ Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne, France.
¹⁴ Service de Médecine Intensive - Réanimation, Centre Hospitalier Intercommunal Robert Ballanger, 93602, Aulnay-sous-Bois, France.

PMID: 31197492
PMCID: PMC6565761
DOI: 10.1186/s13613-019-0540-9

Review

Formal guidelines: management of acute respiratory distress syndrome

Laurent Papazian et al. Ann Intensive Care. 2019.

. 2019 Jun 13;9(1):69.

doi: 10.1186/s13613-019-0540-9.

Authors

Affiliations

¹ Service de Médecine Intensive - Réanimation, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France. Laurent.PAPAZIAN@ap-hm.fr.
² Medical Intensive Care Unit, Centre Hospitalier Régional et Universitaire de Brest, site La Cavale Blanche, Bvd Tanguy Prigent, 29609, Brest Cedex, France.
³ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
⁴ Service de Médecine Intensive - Réanimation, Hôpital Cochin, Hôpitaux Universitaires Paris-Centre, Assistance Publique - Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
⁵ Service de Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié- Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47, boulevard de l'Hôpital, 75013, Paris, France.
⁶ Intensive Care Unit, Louis Mourier Hospital, AP-HP, 178 Rue des Renouillers, 92700, Colombes, France.
⁷ Service de Médecine Intensive - Réanimation, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France.
⁸ Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
⁹ Department of Anesthesiology and Intensive Care (DAR B), Saint Eloi University Hospital, Montpellier, France.
¹⁰ Service de Réanimation Médicale, Hôpitaux Universitaires Henri-Mondor, AP-HP, DHU A-TVB, 94010, Créteil, France.
¹¹ Medical Intensive Care Department, Angers University Hospital, 4, rue Larrey, 49933, Angers Cedex, France.
¹² Emergency Department, General Hospital of Annecy, Annecy, France.
¹³ Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne, France.
¹⁴ Service de Médecine Intensive - Réanimation, Centre Hospitalier Intercommunal Robert Ballanger, 93602, Aulnay-sous-Bois, France.

PMID: 31197492
PMCID: PMC6565761
DOI: 10.1186/s13613-019-0540-9

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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Conflict of interest statement

Laurent Brochard: Philips; General Electric; Fisher Paykel; Air Liquide; Sentec; Medtronic Covidien. Jean-Daniel Chiche: General Electric Healthcare. Alain Combes: Maquet Getinge; Baxter. Samir Jaber: Drager; Fisher Paykel; Xenios. Armand Mekontso-Dessap: Air Liquide; Baxter; Fischer Paykel; Philips. Laurent Papazian: Air Liquide MS; MSD; Drager; Maquet; Medtronic. Jean-Christophe M. Richard: Air Liquide Medical System; Vygon; Covidien; General Electric. Damien Roux: Astellas. Antoine Vieillard-Baron: GSK. The remaining authors declare no competing interests.

Figures

**Fig. 1**
Therapeutic algorithm regarding early ARDS management (EXPERT OPINION)

See this image and copyright information in PMC

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References

1. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526–2533. - PubMed
1. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788–800. doi: 10.1001/jama.2016.0291. - DOI - PubMed
1. Li G, Malinchoc M, Cartin-Ceba R, Venkata CV, Kor DJ, Peters SG, et al. Eight-year trend of acute respiratory distress syndrome: a population-based study in Olmsted County, Minnesota. Am J Respir Crit Care Med. 2011;183(1):59–66. doi: 10.1164/rccm.201003-0436OC. - DOI - PMC - PubMed
1. Villar J, Blanco J, Anon JM, Santos-Bouza A, Blanch L, Ambros A, et al. The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation. Intensive Care Med. 2011;37(12):1932–1941. doi: 10.1007/s00134-011-2380-4. - DOI - PubMed
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[1] Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526–2533. - PubMed

[2] Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526–2533. - PubMed

[3] Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788–800. doi: 10.1001/jama.2016.0291. - DOI - PubMed

[4] Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788–800. doi: 10.1001/jama.2016.0291. - DOI - PubMed

[5] Li G, Malinchoc M, Cartin-Ceba R, Venkata CV, Kor DJ, Peters SG, et al. Eight-year trend of acute respiratory distress syndrome: a population-based study in Olmsted County, Minnesota. Am J Respir Crit Care Med. 2011;183(1):59–66. doi: 10.1164/rccm.201003-0436OC. - DOI - PMC - PubMed

[6] Li G, Malinchoc M, Cartin-Ceba R, Venkata CV, Kor DJ, Peters SG, et al. Eight-year trend of acute respiratory distress syndrome: a population-based study in Olmsted County, Minnesota. Am J Respir Crit Care Med. 2011;183(1):59–66. doi: 10.1164/rccm.201003-0436OC. - DOI - PMC - PubMed

[7] Villar J, Blanco J, Anon JM, Santos-Bouza A, Blanch L, Ambros A, et al. The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation. Intensive Care Med. 2011;37(12):1932–1941. doi: 10.1007/s00134-011-2380-4. - DOI - PubMed

[8] Villar J, Blanco J, Anon JM, Santos-Bouza A, Blanch L, Ambros A, et al. The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation. Intensive Care Med. 2011;37(12):1932–1941. doi: 10.1007/s00134-011-2380-4. - DOI - PubMed

[9] Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293–1304. doi: 10.1056/NEJMoa1011802. - DOI - PubMed

[10] Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293–1304. doi: 10.1056/NEJMoa1011802. - DOI - PubMed

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Formal guidelines: management of acute respiratory distress syndrome

Affiliations

Formal guidelines: management of acute respiratory distress syndrome

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