PMID- 31258917
OWN - NLM
STAT- MEDLINE
DCOM- 20200703
LR  - 20210110
IS  - 2052-4439 (Print)
IS  - 2052-4439 (Electronic)
IS  - 2052-4439 (Linking)
VI  - 6
IP  - 1
DP  - 2019
TI  - Guidelines on the management of acute respiratory distress syndrome.
PG  - e000420
LID - 10.1136/bmjresp-2019-000420 [doi]
LID - e000420
AB  - The Faculty of Intensive Care Medicine and Intensive Care Society Guideline 
      Development Group have used GRADE methodology to make the following 
      recommendations for the management of adult patients with acute respiratory 
      distress syndrome (ARDS). The British Thoracic Society supports the 
      recommendations in this guideline. Where mechanical ventilation is required, the 
      use of low tidal volumes (<6 ml/kg ideal body weight) and airway pressures 
      (plateau pressure <30 cmH(2)O) was recommended. For patients with moderate/severe 
      ARDS (PF ratio<20 kPa), prone positioning was recommended for at least 12 hours 
      per day. By contrast, high frequency oscillation was not recommended and it was 
      suggested that inhaled nitric oxide is not used. The use of a conservative fluid 
      management strategy was suggested for all patients, whereas mechanical 
      ventilation with high positive end-expiratory pressure and the use of the 
      neuromuscular blocking agent cisatracurium for 48 hours was suggested for 
      patients with ARDS with ratio of arterial oxygen partial pressure to fractional 
      inspired oxygen (PF) ratios less than or equal to 27 and 20 kPa, respectively. 
      Extracorporeal membrane oxygenation was suggested as an adjunct to protective 
      mechanical ventilation for patients with very severe ARDS. In the absence of 
      adequate evidence, research recommendations were made for the use of 
      corticosteroids and extracorporeal carbon dioxide removal.
FAU - Griffiths, Mark J D
AU  - Griffiths MJD
AUID- ORCID: 0000-0002-1615-1896
AD  - Peri-Operative Medicine, Barts Health NHS Trust, London, UK.
FAU - McAuley, Danny Francis
AU  - McAuley DF
AD  - Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, 
      Belfast, UK.
FAU - Perkins, Gavin D
AU  - Perkins GD
AD  - Warwick Clinical Trials Unit, University of Warwick, Coventry, West Midlands, UK.
FAU - Barrett, Nicholas
AU  - Barrett N
AD  - Critical Care, Saint Thomas' Hospital, London, UK.
FAU - Blackwood, Bronagh
AU  - Blackwood B
AD  - Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, 
      Belfast, UK.
FAU - Boyle, Andrew
AU  - Boyle A
AD  - Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, 
      Belfast, UK.
FAU - Chee, Nigel
AU  - Chee N
AD  - Academic Department of Critical Care, Queen Alexandra Hospital, Portsmouth 
      Hospitals NHS Trust, Portsmouth, UK.
FAU - Connolly, Bronwen
AU  - Connolly B
AD  - Respiratory Medicine, King's College London, London, UK.
FAU - Dark, Paul
AU  - Dark P
AD  - Division of Infection, Immunity and Respiratory Medicine, NIHR Biomedical 
      Research Centre, University of Manchester, Manchester, Greater Manchester, UK.
FAU - Finney, Simon
AU  - Finney S
AUID- ORCID: 0000-0001-8219-1952
AD  - Peri-Operative Medicine, Barts Health NHS Trust, London, UK.
FAU - Salam, Aemun
AU  - Salam A
AD  - Peri-Operative Medicine, Barts Health NHS Trust, London, UK.
FAU - Silversides, Jonathan
AU  - Silversides J
AD  - Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, 
      Belfast, UK.
FAU - Tarmey, Nick
AU  - Tarmey N
AD  - Academic Department of Critical Care, Queen Alexandra Hospital, Portsmouth 
      Hospitals NHS Trust, Portsmouth, UK.
FAU - Wise, Matt P
AU  - Wise MP
AD  - Intensive Care, Heath Hospital, Cardiff, UK.
FAU - Baudouin, Simon V
AU  - Baudouin SV
AD  - Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
LA  - eng
GR  - HTA/13/143/02/DH_/Department of Health/United Kingdom
GR  - PDF-2015-08-015/DH_/Department of Health/United Kingdom
PT  - Journal Article
PT  - Practice Guideline
DEP - 20190524
PL  - England
TA  - BMJ Open Respir Res
JT  - BMJ open respiratory research
JID - 101638061
RN  - 0 (Glucocorticoids)
MH  - Blood Gas Analysis/standards
MH  - Combined Modality Therapy/methods/standards
MH  - Critical Care/methods/*standards
MH  - Extracorporeal Membrane Oxygenation/*standards
MH  - Glucocorticoids/standards/*therapeutic use
MH  - Humans
MH  - Patient Positioning/methods/standards
MH  - Prone Position
MH  - Respiration, Artificial/methods/*standards
MH  - Respiratory Distress Syndrome/blood/diagnosis/*therapy
MH  - Societies, Medical/standards
MH  - Tidal Volume
MH  - Treatment Outcome
MH  - United Kingdom
PMC - PMC6561387
OTO - NOTNLM
OT  - ARDS
COIS- Competing interests: Each author contributed elements to the final text.
EDAT- 2019/07/02 06:00
MHDA- 2019/07/02 06:01
PMCR- 2019/05/24
CRDT- 2019/07/02 06:00
PHST- 2019/03/07 00:00 [received]
PHST- 2019/04/01 00:00 [revised]
PHST- 2019/07/02 06:00 [entrez]
PHST- 2019/07/02 06:00 [pubmed]
PHST- 2019/07/02 06:01 [medline]
PHST- 2019/05/24 00:00 [pmc-release]
AID - bmjresp-2019-000420 [pii]
AID - 10.1136/bmjresp-2019-000420 [doi]
PST - epublish
SO  - BMJ Open Respir Res. 2019 May 24;6(1):e000420. doi: 10.1136/bmjresp-2019-000420. 
      eCollection 2019.