Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 8;10(1):32.
doi: 10.1186/s40560-022-00615-6.

ARDS Clinical Practice Guideline 2021

Sadatomo Tasaka  1 , Shinichiro Ohshimo  2 , Muneyuki Takeuchi  3 , Hideto Yasuda  4 , Kazuya Ichikado  5 , Kenji Tsushima  6 , Moritoki Egi  7 , Satoru Hashimoto  8 , Nobuaki Shime  2 , Osamu Saito  9 , Shotaro Matsumoto  10 , Eishu Nango  11 , Yohei Okada  12 , Kenichiro Hayashi  13 , Masaaki Sakuraya  14 , Mikio Nakajima  15 , Satoshi Okamori  16 , Shinya Miura  17 , Tatsuma Fukuda  18 , Tadashi Ishihara  19 , Tetsuro Kamo  20 , Tomoaki Yatabe  21 , Yasuhiro Norisue  22 , Yoshitaka Aoki  23 , Yusuke Iizuka  24 , Yutaka Kondo  25 , Chihiro Narita  26 , Daisuke Kawakami  27 , Hiromu Okano  28 , Jun Takeshita  29 , Keisuke Anan  30 , Satoru Robert Okazaki  31 , Shunsuke Taito  32 , Takuya Hayashi  33 , Takuya Mayumi  34 , Takero Terayama  35 , Yoshifumi Kubota  36 , Yoshinobu Abe  37 , Yudai Iwasaki  38 , Yuki Kishihara  39 , Jun Kataoka  40 , Tetsuro Nishimura  41 , Hiroshi Yonekura  42 , Koichi Ando  43 , Takuo Yoshida  44 , Tomoyuki Masuyama  45 , Masamitsu Sanui  24 ; ARDS Clinical Practice Guideline 2021 committee from the Japanese Society of Intensive Care Medicine, the Japanese Respiratory Society, and the Japanese Society of Respiratory Care Medicine
Collaborators, Affiliations

ARDS Clinical Practice Guideline 2021

Sadatomo Tasaka et al. J Intensive Care. .

Abstract

Background: The joint committee of the Japanese Society of Intensive Care Medicine/Japanese Respiratory Society/Japanese Society of Respiratory Care Medicine on ARDS Clinical Practice Guideline has created and released the ARDS Clinical Practice Guideline 2021.

Methods: The 2016 edition of the Clinical Practice Guideline covered clinical questions (CQs) that targeted only adults, but the present guideline includes 15 CQs for children in addition to 46 CQs for adults. As with the previous edition, we used a systematic review method with the Grading of Recommendations Assessment Development and Evaluation (GRADE) system as well as a degree of recommendation determination method. We also conducted systematic reviews that used meta-analyses of diagnostic accuracy and network meta-analyses as a new method.

Results: Recommendations for adult patients with ARDS are described: we suggest against using serum C-reactive protein and procalcitonin levels to identify bacterial pneumonia as the underlying disease (GRADE 2D); we recommend limiting tidal volume to 4-8 mL/kg for mechanical ventilation (GRADE 1D); we recommend against managements targeting an excessively low SpO2 (PaO2) (GRADE 2D); we suggest against using transpulmonary pressure as a routine basis in positive end-expiratory pressure settings (GRADE 2B); we suggest implementing extracorporeal membrane oxygenation for those with severe ARDS (GRADE 2B); we suggest against using high-dose steroids (GRADE 2C); and we recommend using low-dose steroids (GRADE 1B). The recommendations for pediatric patients with ARDS are as follows: we suggest against using non-invasive respiratory support (non-invasive positive pressure ventilation/high-flow nasal cannula oxygen therapy) (GRADE 2D), we suggest placing pediatric patients with moderate ARDS in the prone position (GRADE 2D), we suggest against routinely implementing NO inhalation therapy (GRADE 2C), and we suggest against implementing daily sedation interruption for pediatric patients with respiratory failure (GRADE 2D).

Conclusions: This article is a translated summary of the full version of the ARDS Clinical Practice Guideline 2021 published in Japanese (URL: https://www.jsicm.org/publication/guideline.html ). The original text, which was written for Japanese healthcare professionals, may include different perspectives from healthcare professionals of other countries.

Keywords: ARDS; Acute lung injury; Clinical practice guideline; Systematic review.

PubMed Disclaimer

Conflict of interest statement

All committee members and panelists submitted disclosure forms of financial and academic conflict of interest (COI) prior to being requested to participate in individual activities. If panelists have any COI concerning each CQ, other panelists were assigned to replace the vacancy. All COI were collected according to the guideline written by Japanese Society of Intensive Care Medicine. Detailed information of COI and the roles in creating this clinical guideline are summarized in Additional file 7.

References

    1. Japanese Society of Respiratory Care Medicine ARDS clinical practice guidelines 1st edition. Jpn J Respir Care. 1999;16:95–115.
    1. Japanese Society of Respiratory Care Medicine ARDS clinical practice guidelines 2nd edition. Jpn J Respir Care. 1999;21:44–61.
    1. Japanese Respiratory Society ARDS Guideline Committee. Clinical practical guideline for acute lung injury and acute respiratory distress syndrome; 2005. (In Japanese)
    1. Japanese Respiratory Society ARDS Guideline Committee. Clinical practical guideline for acute lung injury and acute respiratory distress syndrome 2nd edition. 2010. (In Japanese). - PubMed
    1. Hashimoto S, Sanui M, Egi M, et al. The clinical practice guideline for the management of ARDS in Japan. J Intensive Care. 2017 doi: 10.1186/s40560-017-0222-3. - DOI - PMC - PubMed