7. An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline

An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline

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Average read time: 30-40 minutes

Short Summary of the Article:

The article, issued by the American Thoracic Society, provides updated clinical practice guidelines for the management of Adult Respiratory Distress Syndrome (ARDS). The guidelines incorporate new evidence on various treatments, including the use of corticosteroids, venovenous extracorporeal membrane oxygenation (VV-ECMO), neuromuscular blocking agents, and positive end-expiratory pressure (PEEP). These recommendations are based on a multidisciplinary panel’s review of the latest evidence using the GRADE framework.

Key points include:

1. Corticosteroids: Suggested for ARDS patients due to their moderate certainty of reducing mortality and shortening hospital stays.
2. VV-ECMO: Recommended in specific cases of severe ARDS, particularly when other treatments are not effective, though with low certainty due to its invasive nature.
3. Neuromuscular Blockade: Recommended in the early stages of severe ARDS to possibly reduce mortality, though evidence certainty is low.
4. PEEP: Higher PEEP without lung recruitment maneuvers is recommended for moderate to severe ARDS cases, while prolonged lung recruitment maneuvers are not recommended due to potential harm

Learning Outcomes 

Upon completion of this activity, you should have an understanding of:

1. The Use of Corticosteroids in ARDS: You will understand when corticosteroids are recommended for ARDS treatment, their benefits in reducing mortality, and potential risks associated with their use.
2. VV-ECMO in Severe ARDS: You will learn the criteria for selecting patients for VV-ECMO treatment in severe ARDS, including the invasive nature and resource-intensity of this approach.
3. Application of Neuromuscular Blocking Agents and PEEP: You will understand the recommendations for using neuromuscular blocking agents in early severe ARDS, the reasoning behind higher PEEP strategies, and why lung recruitment maneuvers should be avoided in certain patients.