Intensive Care Medicine published 16 June 2023
The aim of these
guidelines is to update the 2017 clinical practice guideline (CPG) of the
European Society of Intensive Care Medicine (ESICM). The scope of this CPG is
limited to adult patients and to non-pharmacological respiratory support
strategies across different aspects of
acute respiratory
distress syndrome
(ARDS),
including ARDS due to coronavirus disease 2019 (COVID-19). These guidelines
were formulated by an international panel of clinical experts, one
methodologist and patients’ representatives on behalf of the ESICM. The review
was conducted in compliance with the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) statement recommendations. We followed the
Grading of Recommendations Assessment, Development, and Evaluation (GRADE)
approach to assess the certainty of evidence and grade recommendations and the
quality of reporting of each study based on the EQUATOR (Enhancing the QUAlity
and Transparency Of health Research) network guidelines. The CPG addressed 21
questions and formulates 21 recommendations on the following domains: (1)
definition; (2) phenotyping, and respiratory support strategies including (3)
high-flow nasal cannula oxygen (HFNO); (4) non-invasive ventilation (NIV); (5)
tidal volume setting; (6) positive end-expiratory pressure (PEEP) and
recruitment maneuvers (RM); (7) prone positioning; (8) neuromuscular blockade,
and (9) extracorporeal life support (ECLS). In addition, the CPG includes
expert opinion on clinical practice and identifies the areas of future
research.
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