{"id":24245,"date":"2023-06-27T04:30:00","date_gmt":"2023-06-26T20:30:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=24245"},"modified":"2023-06-27T05:49:18","modified_gmt":"2023-06-26T21:49:18","slug":"intensive-care-med%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9aesicm%e6%9c%89%e5%85%b3ards%e7%9a%84%e6%8c%87%e5%8d%972-3","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=24245","title":{"rendered":"[Intensive Care Med\u53d1\u8868\u8bba\u6587]\uff1aESICM\u6709\u5173ARDS\u7684\u6307\u5357(2\/3)"},"content":{"rendered":"\n<ul>\n<li>Conference Reports and Expert Panel<\/li>\n\n\n\n<li><a href=\"https:\/\/www.springernature.com\/gp\/open-research\/about\/the-fundamentals-of-open-access-and-open-research\">Open Access<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/link.springer.com\/article\/10.1007\/s00134-023-07050-7#article-info\">Published:&nbsp;<time datetime=\"2023-06-16\">16 June 2023<\/time><\/a><\/li>\n<\/ul>\n\n\n\n<h1 class=\"wp-block-heading\">ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies<\/h1>\n\n\n\n<h3 class=\"wp-block-heading\">Grasselli, G., Calfee, C.S., Camporota, L.&nbsp;<em>et al.<\/em><\/h3>\n\n\n\n<h3 class=\"wp-block-heading\"><em>Intensive Care Med<\/em>&nbsp;(2023). https:\/\/doi.org\/10.1007\/s00134-023-07050-7<\/h3>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"Sec33\">Domain 6: PEEP and recruitment maneuvers<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"Sec4785\">Question 6.1: In patients with ARDS undergoing invasive mechanical ventilation, does&nbsp;<em>routine<\/em>&nbsp;PEEP titration using a higher PEEP\/FiO<sub><em>2<\/em><\/sub>&nbsp;strategy compared to a lower PEEP\/FiO<sub><em>2<\/em><\/sub>&nbsp;strategy reduce mortality?<\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">Recommendation 6.1<\/th><\/tr><\/thead><tbody><tr><td class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">We are&nbsp;<strong>unable to make a recommendation<\/strong>&nbsp;for or against routine PEEP titration with a higher PEEP\/FiO<sub>2<\/sub>&nbsp;strategy versus a lower PEEP\/FiO<sub>2<\/sub>&nbsp;strategy to reduce mortality in patients with ARDS.<em>No recommendation; high level of evidence of no effect.<\/em><\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">This statement applies also to ARDS from COVID-19.<em>No recommendation; moderate level of evidence of no effect for indirectness.<\/em><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"Sec5874\">Question 6.2: In patients with ARDS undergoing invasive mechanical ventilation, does&nbsp;<em>routine<\/em>&nbsp;PEEP titration based principally on respiratory mechanics compared to PEEP titration based principally on a standardized PEEP\/FiO<sub><em>2<\/em><\/sub>&nbsp;table reduce mortality?<\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">Recommendation 6.2<\/th><\/tr><\/thead><tbody><tr><td class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">We are&nbsp;<strong>unable to make a recommendation<\/strong>&nbsp;for or against PEEP titration guided principally by respiratory mechanics, compared to PEEP titration based principally on PEEP\/FiO<sub>2<\/sub>&nbsp;strategy, to reduce mortality in patients with ARDS.<em>No recommendation; high level of evidence of no effect.<\/em><\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">This statement applies also to ARDS from COVID-19.<em>No recommendation; moderate level of evidence for indirectness.<\/em><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Question 6.3: In patients with ARDS undergoing invasive mechanical ventilation, does use of prolonged high-pressure recruitment maneuvers, compared to not using prolonged high-pressure RMs, reduce mortality?<\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">Recommendation 6.3<\/th><\/tr><\/thead><tbody><tr><td class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">We&nbsp;<strong>recommend against<\/strong>&nbsp;use of prolonged high-pressure recruitment maneuvers (defined as airway pressure maintained\u2009\u2265\u200935&nbsp;cmH<sub>2<\/sub>O for at least one minute) to reduce mortality of patients with ARDS.<em>Strong recommendation; moderate level of evidence against.<\/em><\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">This recommendation applies also to ARDS from COVID-19.<em>Strong recommendation; low level of evidence against for indirectness.<\/em><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"Sec5558\">Question 6.4: In patients with ARDS undergoing invasive mechanical ventilation, does&nbsp;<em>routine<\/em>&nbsp;use of brief high-pressure recruitment maneuvers, compared to no use of brief high-pressure recruitment maneuvers, reduce mortality?<\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">Recommendation 6.4<\/th><\/tr><\/thead><tbody><tr><td class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">We&nbsp;<strong>suggest against<\/strong>&nbsp;<em>routine<\/em>&nbsp;use of brief high-pressure recruitment maneuvers (defined as airway pressure maintained\u2009\u2265\u200935&nbsp;cmH<sub>2<\/sub>O for less than one minute) to reduce mortality in patients with ARDS.<em>Weak recommendation; high level of evidence of no effect.<\/em><\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">This suggestion applies also to ARDS from COVID-19.<em>Weak recommendation; moderate level of evidence of no effect for indirectness.<\/em><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"Sec45\">Domain 7: Prone positioning<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"Sec25413\">Question 7.1: In intubated patients with ARDS, does prone position compared to supine position reduce mortality?<\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">Recommendation 7.1<\/th><\/tr><\/thead><tbody><tr><td class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">We&nbsp;<strong>recommend<\/strong>&nbsp;using prone position as compared to supine position for patients with moderate-severe ARDS (defined as PaO<sub>2<\/sub>\/FiO<sub>2<\/sub>\u2009&lt;\u2009150&nbsp;mmHg and PEEP\u2009\u2265\u20095 cmH<sub>2<\/sub>O, despite optimization of ventilation settings) to reduce mortality.<em>Strong recommendation, high level of evidence in favor.<\/em><\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">This recommendation applies also to ARDS from COVID-19.<em>Strong recommendation; moderate level of evidence in favor for indirectness.<\/em><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"Sec3252\">Question 7.2: In patients with moderate-severe ARDS, when should prone positioning be started to reduce mortality?<\/h3>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"Sec50\">Background<\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">Recommendation 7.2<\/th><\/tr><\/thead><tbody><tr><td class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">We&nbsp;<strong>recommend<\/strong>&nbsp;starting prone position in patients with ARDS receiving invasive mechanical ventilation early after intubation, after a period of stabilization during which low tidal volume is applied and PEEP adjusted and at the end of which the PaO<sub>2<\/sub>\/FiO<sub>2<\/sub>&nbsp;remains\u2009&lt;\u2009150&nbsp;mmHg; and proning should be applied for prolonged sessions (16 consecutive hours or more) to reduce mortality.<em>Strong recommendation; high level of evidence in favor.<\/em><\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">This recommendation applies also to ARDS from COVID-19.<em>Strong recommendation; moderate level of evidence in favor for indirectness.<\/em><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Question 7.3: In non intubated patients with AHRF, does awake prone positioning (APP) as compared to supine positioning reduce intubation or mortality?<\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th colspan=\"2\">Recommendation 7.3<\/th><\/tr><\/thead><tbody><tr><td colspan=\"2\">We&nbsp;<strong>suggest<\/strong>&nbsp;awake prone positioning as compared to supine positioning for non-intubated patients with COVID-19-related AHRF to reduce intubation.<em>Weak recommendation; low level of evidence in favor.<\/em><\/td><\/tr><tr><td colspan=\"2\">We are&nbsp;<strong>unable to make a recommendation<\/strong>&nbsp;for or against APP for non-intubated patients with COVID-19-related AHRF to reduce mortality.<em>No recommendation; moderate level of evidence of no effect.<\/em><\/td><\/tr><tr><td colspan=\"2\">We are&nbsp;<strong>unable to make a recommendation<\/strong>&nbsp;for or against APP for patients with AHRF not due to COVID-19.<em>No recommendation; no evidence.<\/em><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"Sec57\">Domain 8: Neuromuscular blocking agents<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"Sec2541\">Question 8.1: Does the&nbsp;<em>routine<\/em>&nbsp;use of a continuous infusion of neuromuscular blocking agents (NMBA) in patients with moderate-to-severe ARDS not due to COVID-19 or moderate-to-severe ARDS due to COVID-19 reduce mortality?<\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">Recommendation 8.1<\/th><\/tr><\/thead><tbody><tr><td class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">We&nbsp;<strong>recommend against<\/strong>&nbsp;the&nbsp;<em>routine<\/em>&nbsp;use of continuous infusions of NMBA to reduce mortality in patients with moderate-to-severe ARDS not due to COVID-19.<em>Strong recommendation, moderate level of evidence.<\/em><\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\" colspan=\"2\">We are&nbsp;<strong>unable to make a recommendation<\/strong>&nbsp;for or against the&nbsp;<em>routine<\/em>&nbsp;use of continuous infusions of NMBA to reduce mortality in patients with moderate-to-severe ARDS due to COVID-19.<em>No recommendation; no evidence.<\/em><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"Sec62\">Domain 9: Extracorporeal life support<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"Sec25840\">Question 9.1: In adult patients with severe acute respiratory distress syndrome (ARDS) or COVID-19 does veno-venous extracorporeal membrane oxygenation (VV-ECMO) compared with conventional ventilation improve outcomes?<\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th class=\"has-text-align-left\" data-align=\"left\">Recommendation 9.1<\/th><\/tr><\/thead><tbody><tr><td class=\"has-text-align-left\" data-align=\"left\">We&nbsp;<strong>recommend<\/strong>&nbsp;that patients with severe ARDS not due to COVID-19 as defined by the EOLIA trial eligibility criteria, should be treated with ECMO in an ECMO center which meets defined organizational standards, adhering to a management strategy similar to that used in the EOLIA trial.<em>Strong recommendation, moderate level of evidence in favor<\/em><\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\">This recommendation applies also to patients with severe ARDS due to COVID-19.<em>Strong recommendation; low level of evidence in favor for indirectness.<\/em><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Question 9.2: In adult patients with ARDS, does extracorporeal carbon dioxide removal (ECCO<sub><em>2<\/em><\/sub>R) compared with conventional ventilation improve outcomes?<\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th class=\"has-text-align-left\" data-align=\"left\">Recommendation 9.2<\/th><\/tr><\/thead><tbody><tr><td class=\"has-text-align-left\" data-align=\"left\">We&nbsp;<strong>recommend against<\/strong>&nbsp;the use of ECCO<sub>2<\/sub>R for the treatment of ARDS not due to COVID-19 to prevent mortality outside of randomized controlled trials.<em>Strong recommendation, high level of evidence of no effect.<\/em><\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\">This recommendation applies also to patients with severe ARDS due to COVID-19.<em>Strong recommendation; moderate level of evidence of no effect for indirectness.<\/em><\/td><\/tr><\/tbody><\/table><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>ESICM guidelines on acute respiratory distress syndrome [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[25,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24245"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24245"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24245\/revisions"}],"predecessor-version":[{"id":24252,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24245\/revisions\/24252"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24245"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24245"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24245"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}