{"id":29972,"date":"2026-03-09T04:17:00","date_gmt":"2026-03-08T20:17:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=29972"},"modified":"2026-03-09T06:19:24","modified_gmt":"2026-03-08T22:19:24","slug":"intensive-care-med%e5%8f%91%e8%a1%a8%e7%bb%bc%e8%bf%b0%ef%bc%9aards%e7%9a%84%e6%b2%bb%e7%96%97","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=29972","title":{"rendered":"[Intensive Care Med\u53d1\u8868\u7efc\u8ff0]\uff1aARDS\u7684\u6cbb\u7597"},"content":{"rendered":"\n

The medical management of acute respiratory distress syndrome<\/h1>\n\n\n\n

Idunn S. Morris,\u00a0Marcelo Amato,\u00a0Elias Baedorf Kassis,\u00a0et al<\/h3>\n\n\n\n

Intensive Care Med 2025<\/h3>\n\n\n\n

https:\/\/doi.org\/10.1007\/s00134-025-08251-y<\/h3>\n\n\n\n
Non-invasive respiratory support<\/strong><\/td><\/tr>
Non-invasive ventilation<\/td><\/tr>
 Commence early in patients with mild\u2013moderate ARDS If available, helmet over face mask NIV may be better tolerated Uptitrate PEEP, aiming to optimise the work of breathing Titrate pressure support to target Vt 6\u20138 ml\/kg PBW Monitor closely for changes in tidal volume, minute ventilation, acid\u2013base, work of breathing, hypoxaemia, and haemodynamics Assess success or failure of strategy within 1\u20132 h of commencement Do not delay intubation when indicated, otherwise continue to review frequently<\/td><\/tr>
High-flow oxygen<\/td><\/tr>
 Commence early in patients with mild ARDS Consider high-flow oxygen preferentially over NIV in patients with high sputum load Target flows 40\u201360 L\/min, as tolerated<\/td><\/tr>
Invasive mechanical ventilation<\/strong><\/td><\/tr>
Tidal volume<\/td><\/tr>
 Target Vt 6 (4\u20138) ml\/kg PBW If  P\u2009\u2265\u200916 cmH2<\/sub>O (after PEEP optimisation), consider targeting lower (4\u20136 ml\/kg PBW) range if RR and acid\u2013base allow If known or high risk for RV dysfunction (see below) and acid\u2013base allows (minimise hypercapnoea), target 4\u20136 ml\/kg PBW to reduce mean airway pressure<\/td><\/tr>
Plateau pressure<\/td><\/tr>
 During passive ventilation, target Pplat\u2009<\u200930 cmH2<\/sub>O If high pleural pressures present (e.g. abdominal distension, central obesity), higher Pplat may be appropriate (e.g. 30\u201335 cmH2<\/sub>O); consider use of oesophageal manometry if available If known or high risk for RV dysfunction, following PEEP optimisation, target Pplat\u2009<\u200926\u201328 cmH2<\/sub>O, or as low as safely able<\/td><\/tr>
Positive end-expiratory pressure<\/td><\/tr>
 PEEP\u2013FiO2<\/sub> table reasonable starting point immediately following intubation, prior to assessment of respiratory mechanics, recruitability, and personalised PEEP titration Lower range of PEEP\u2013FiO2<\/sub> table if non-recruitable and concerns for RV or ICP, higher range if anticipating high pleural pressures (e.g. abdominal distension, central obesity) Assess recruitability and benefit of higher PEEP in moderate\u2013severe ARDS Avoid high-PEEP strategy in patients with mild and\/or focal ARDS Create and follow local guidelines on PEEP assessment based on local tools and expertise Reassess optimal PEEP regularly, to include change in clinical status and\/or following new intervention that may alter respiratory mechanics (e.g. prone position, NMBA)<\/td><\/tr>
Controlled mode<\/td><\/tr>
 Volume or pressure targeted mode as per familiarity of the clinician and unit Consider hybrid mode (e.g. assist control) upfront to aid patient\u2013ventilator synchrony Set appropriate pressure and volume alarms as per targets determined above<\/td><\/tr>
Oxygen targets<\/td><\/tr>
 Target SpO2<\/sub> 90\u201395% and\/or PaO2<\/sub> 60\u201380 mmHg Higher end of target range desirable in patients with acute RV dysfunction<\/td><\/tr>
Permissive hypercapnoea<\/td><\/tr>
 Maintain pH\u2009>\u20097.25 In patients with or at risk of RV dysfunction, tolerance of a permissive hypercapnoea requires serial assessment of haemodynamics and RV function<\/td><\/tr>
Non-ventilatory management<\/strong><\/td><\/tr>
Prone positioning<\/td><\/tr>
 Early (<\u200936 h from invasive mechanical ventilation and ARDS diagnosis) in patients with PaO2<\/sub>\/FiO2<\/sub>\u2009<\u2009150 mmHg on optimised PEEP and FiO2<\/sub>\u2009\u2265\u20090.6 Daily sessions\u2009\u2265\u200912 h per day, continuing until PaO2<\/sub>\/FiO2<\/sub>\u2009\u2265\u2009150 mmHg, PEEP\u2009\u2264\u200910 cmH2<\/sub>O and FiO2<\/sub>\u2009\u2264\u20090.6 for\u2009\u2265\u20094 h after supination Lack of observable benefit (oxygenation or other) is not an indication to discontinue prone positioning. Discontinue only if safety concerns develop (significant haemodynamic instability, worsening respiratory mechanics, etc.) Neuromuscular blockade is not required by default, but may be appropriate in some cases<\/td><\/tr>
Neuromuscular blockade<\/td><\/tr>
 Consider in early (<\u200948 h) severe (PaO2<\/sub>\/FiO2 \u2264<\/sub>100 mmHg) ARDS with hypoxaemia Use in moderate\u2013severe ARDS (PaO2<\/sub>\/FiO2 \u2264<\/sub>150 mmHg) with an indication for deep sedation (patient\u2013ventilator dyssynchrony and\/or high respiratory drive and effort) Use if impaired respiratory mechanics, after a trial bolus favouring potential benefit Review cessation at 48 h<\/td><\/tr>
Steroids<\/td><\/tr>
 Use if indicated by other pathology with proven or likely benefitInsufficient evidence to support routine use in ARDS<\/td><\/tr>
Fluid management<\/td><\/tr>
 In patients without shock, a conservative fluid strategy (targeting neutral cumulative fluid balance) initiated early is preferred over diuresis later<\/td><\/tr>
Cardiorespiratory monitoring<\/strong><\/td><\/tr>
Ventilation: non-invasive<\/td><\/tr>
 Clinical assessment of work of breathing and dyspnoea score RR, Vt, minute ventilation, consciousness, heart rate, andblood pressure Oxygenation and acid\u2013base assessment (continuous SpO2<\/sub> monitoring and intermittent blood gas analysis) Assess circuit leaks, patient tolerance, and pressure areas<\/td><\/tr>
Ventilation: invasive<\/td><\/tr>
 Passive: PEEPt, Pplat, P (computed from Pplat\u2013PEEPt), Vt (adjusted to PBW), RR Spontaneous efforts; Vt, RR, magnitude of efforts (local institution dependent), patient\u2013ventilator synchrony by ventilator waveform analysis and\/or invasive monitoring (e.g. oesophageal manometry) All: continuous pulse oximetry and end-tidal CO2<\/sub> monitoring where available, correlate with intermittent blood gas analysis as indicated<\/td><\/tr>
Right ventricle<\/td><\/tr>
 Echocardiographic assessment indicated if (i) pneumonia, (ii) P\u2009\u2265\u200918 cmH2<\/sub>O, (iii) PaO2<\/sub>\/FiO2<\/sub>\u2009<\u2009150 mmHg, (iv) PaCO2<\/sub>\u2009\u2265\u200948 mmHg, (v) shock, and (vi) known or likely pre-existing RV disease Serial echocardiography and\/or PAC-based haemodynamic monitoring to guide interventions during IMV if (i) baseline echo is concerning for RV dysfunction, (ii) plan for permissive hypercapnoea, (iii) moderate\u2013severe shock, or (iv) cardiorespiratory deterioration Monitor for shock, renal failure, congestive hepatopathy, and positive fluid balance<\/td><\/tr><\/tbody><\/table><\/figure>\n","protected":false},"excerpt":{"rendered":"

The medical management of acute respiratory distress sy […]<\/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\/29972"}],"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=29972"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29972\/revisions"}],"predecessor-version":[{"id":29973,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29972\/revisions\/29973"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=29972"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=29972"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=29972"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}