Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome

Publication Date: May 1, 2017
Last Updated: December 16, 2022

Recommendations

The ATS, ESICM, and SCCM recommend that adult patients with ARDS receive mechanical ventilation with strategies that limit tidal volumes (4–8 ml/kg predicted body weight –PBW2) and inspiratory pressures (plateau pressure <30 cm HO) (S, M)
620
The ATS, ESICM, and SCCM recommend that adult patients with severe ARDS receive prone positioning for >12 hours per day. (S, M)
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The ATS, ESICM, and SCCM recommend that high-frequency oscillatory (HFOV) NOT be used routinely in patients with moderate or severe ARDS. (S, M)
620
The ATS, ESICM, and SCCM suggest that adult patients with moderate or severe ARDS receive higher rather than lower levels of positive end-expiratory pressure (PEEP). (C, M)
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The ATS, ESICM, and SCCM suggest that adult patients with moderate or severe ARDS receive recruitment maneuvers (RMs). (C, L)
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Recommendation Grading

Overview

Title

Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome

Authoring Organizations

American Thoracic Society

European Society of Intensive Care Medicine

Society of Critical Care Medicine

Publication Month/Year

May 1, 2017

Last Updated Month/Year

November 22, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This document provides evidence-based clinical practice guidelines on the use of mechanical ventilation in adult patients with acute respiratory distress syndrome (ARDS).

Target Patient Population

Adult patients with acute respiratory distress syndrome (ARDS)

PICO Questions

  1. Should Patients with ARDS Receive Mechanical Ventilation Using Lower Tidal Volumes and Inspiratory Pressures?

  2. Should Patients with ARDS Receive Prone Positioning?

  3. Should Patients with ARDS Receive High-Frequency Oscillatory Ventilation?

  4. Should Patients with ARDS Receive Higher, as Compared with Lower, Positive End-Expiratory Pressure?

  5. Should Patients with ARDS Receive Recruitment Maneuvers?

  6. Should Patients with ARDS Receive Extracorporeal Membrane Oxygenation?

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Emergency care, Hospital, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D012128 - Respiratory Distress Syndrome, Adult, D012122 - Ventilators, Mechanical

Keywords

acute respiratory distress syndrome, mechanical ventilation, critical care, ARDS

Source Citation

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 J, Brochard LJ; 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. Am J Respir Crit Care Med. 2017;195(9):1253–1263.