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

Eddy Fan, Lorenzo Del Sorbo, Ewan C. Goligher, Carol L. Hodgson, Laveena Munshi, Allan J. Walkey, Neill K.J. Adhikari, Marcelo B.P. Amato, Richard Branson, Roy G. Brower, Niall D. Ferguson, Ognjen Gajic, Luciano Gattinoni, Dean Hess, Jordi Mancebo, Maureen O. Meade, Daniel F. McAuley, Antonio Pesenti, V. Marco Ranieri, Gordon D. Rubenfeld & 10 others Eileen Rubin, Maureen Seckel, Arthur S Slutsky, Daniel Talmor, B. Taylor Thompson, Hannah Wunsch, Elizabeth Uleryk, Jan L Brozek, Laurent J. Brochard, on behalf of the American Thoracic Society, European Society of Intensive Care Medicine, and Society of Critical Care Medicine

Research output: Contribution to journalArticleOtherpeer-review

189 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1253-1263
Number of pages11
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume195
Issue number9
DOIs
Publication statusPublished - 1 May 2017

Cite this

Fan, E., Del Sorbo, L., Goligher, E. C., Hodgson, C. L., Munshi, L., Walkey, A. J., ... on behalf of the American Thoracic Society, European Society of Intensive Care Medicine, and Society of Critical Care Medicine (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), 1253-1263. https://doi.org/10.1164/rccm.201703-0548ST
Fan, Eddy ; Del Sorbo, Lorenzo ; Goligher, Ewan C. ; Hodgson, Carol L. ; Munshi, Laveena ; Walkey, Allan J. ; Adhikari, Neill K.J. ; Amato, Marcelo B.P. ; Branson, Richard ; Brower, Roy G. ; Ferguson, Niall D. ; Gajic, Ognjen ; Gattinoni, Luciano ; Hess, Dean ; Mancebo, Jordi ; Meade, Maureen O. ; McAuley, Daniel F. ; Pesenti, Antonio ; Ranieri, V. Marco ; Rubenfeld, Gordon D. ; Rubin, Eileen ; Seckel, Maureen ; Slutsky, Arthur S ; Talmor, Daniel ; Thompson, B. Taylor ; Wunsch, Hannah ; Uleryk, Elizabeth ; Brozek, Jan L ; Brochard, Laurent J. ; on behalf of the American Thoracic Society, European Society of Intensive Care Medicine, and Society of Critical Care Medicine. / 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. In: American Journal of Respiratory and Critical Care Medicine. 2017 ; Vol. 195, No. 9. pp. 1253-1263.
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title = "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",
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.",
author = "Eddy Fan and {Del Sorbo}, Lorenzo and Goligher, {Ewan C.} and Hodgson, {Carol L.} and Laveena Munshi and Walkey, {Allan J.} and Adhikari, {Neill K.J.} and Amato, {Marcelo B.P.} and Richard Branson and Brower, {Roy G.} and Ferguson, {Niall D.} and Ognjen Gajic and Luciano Gattinoni and Dean Hess and Jordi Mancebo and Meade, {Maureen O.} and McAuley, {Daniel F.} and Antonio Pesenti and Ranieri, {V. Marco} and Rubenfeld, {Gordon D.} and Eileen Rubin and Maureen Seckel and Slutsky, {Arthur S} and Daniel Talmor and Thompson, {B. Taylor} and Hannah Wunsch and Elizabeth Uleryk and Brozek, {Jan L} and Brochard, {Laurent J.} and {on behalf of the American Thoracic Society, European Society of Intensive Care Medicine, and Society of Critical Care Medicine}",
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Fan, E, Del Sorbo, L, Goligher, EC, Hodgson, CL, Munshi, L, Walkey, AJ, Adhikari, NKJ, Amato, MBP, Branson, R, Brower, RG, Ferguson, ND, Gajic, O, Gattinoni, L, Hess, D, Mancebo, J, Meade, MO, McAuley, DF, Pesenti, A, Ranieri, VM, Rubenfeld, GD, Rubin, E, Seckel, M, Slutsky, AS, Talmor, D, Thompson, BT, Wunsch, H, Uleryk, E, Brozek, JL, Brochard, LJ & on behalf of the American Thoracic Society, European Society of Intensive Care Medicine, and Society of Critical Care Medicine 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, vol. 195, no. 9, pp. 1253-1263. https://doi.org/10.1164/rccm.201703-0548ST

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. / Fan, Eddy; Del Sorbo, Lorenzo; Goligher, Ewan C.; Hodgson, Carol L.; Munshi, Laveena; Walkey, Allan J.; Adhikari, Neill K.J.; Amato, Marcelo B.P.; Branson, Richard; Brower, Roy G.; Ferguson, Niall D.; Gajic, Ognjen; Gattinoni, Luciano; Hess, Dean; Mancebo, Jordi; Meade, Maureen O.; McAuley, Daniel F.; Pesenti, Antonio; Ranieri, V. Marco; Rubenfeld, Gordon D.; Rubin, Eileen; Seckel, Maureen; Slutsky, Arthur S; Talmor, Daniel; Thompson, B. Taylor; Wunsch, Hannah; Uleryk, Elizabeth; Brozek, Jan L; Brochard, Laurent J.; on behalf of the American Thoracic Society, European Society of Intensive Care Medicine, and Society of Critical Care Medicine.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 195, No. 9, 01.05.2017, p. 1253-1263.

Research output: Contribution to journalArticleOtherpeer-review

TY - JOUR

T1 - An official American Thoracic Society/European Society of intensive care medicine/society of critical care medicine clinical practice guideline

T2 - 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 L

AU - Brochard, Laurent J.

AU - on behalf of the American Thoracic Society, European Society of Intensive Care Medicine, and Society of Critical Care Medicine

PY - 2017/5/1

Y1 - 2017/5/1

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.

AB - 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.

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U2 - 10.1164/rccm.201703-0548ST

DO - 10.1164/rccm.201703-0548ST

M3 - Article

VL - 195

SP - 1253

EP - 1263

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

SN - 1073-449X

IS - 9

ER -