The ARDS Network was established as a contract program in and renewed in following two national competitions. The goal of the Network was to efficiently test promising agents, devices, or management strategies to improve the care of patients with ARDS. During its 20 years of service, 5, patients were enrolled in 10 randomized controlled trials and one observational study In some of the most highly cited articles in critical care, network investigators reported improved survival with lung protective ventilation and shortened duration of mechanical ventilation with conservative fluid management. Additional trials informed best practices by suggesting no role for routine use of corticosteroids, beta agonists, pulmonary artery catheterization, or early full calorie enteral nutrition. The ARDS Network also developed new outcome measures ventilator free days and promoted innovative and efficient techniques factorial designs and coenrollment to speed the discovery of new treatment approaches for patients with ARDS. Finally, through the foresight of many investigators within the Network, additional resources were obtained for the collection and analysis of biospecimens and to perform numerous ancillary studies, efforts that have advanced our understanding of the pathogenesis and natural history of ARDS.
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No commercial re-use. See rights and permissions. Published by BMJ. This article has been cited by other articles in PMC. The British Thoracic Society supports the recommendations in this guideline. 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.
Keywords: ARDS Introduction Aims The purpose of this guideline is to provide an evidence-based framework for the management of adult patients with acute respiratory distress syndrome ARDS that will inform both key decisions in the care of individual patients and broader policy.
Our recommendations are neither dictates nor standards of care. We cannot take into account all of the features of individual patients and complex local factors; all we can do is to synthesise relevant evidence and to put it into the context of current critical care medicine.
Similarly, our recommendations are not comprehensive: these guidelines have relevance to a fraction of the total number of decisions that are required of carers for these complex patients.
Indeed, the current state of the art for the management of ARDS has been recently reviewed 1—4 and comparable guidelines have been produced by national and international stakeholders. Popular topics were excluded by the GDG if it was felt that there was a dearth of evidence eg, appropriate diagnostic investigations and the role of specialist centres , when the evidence was not specific to ARDS weaning from mechanical ventilation, nutrition and the timing of tracheostomy and if there was overlap with existing guidelines post-ICU intensive care unit care and rehabilitation.
This iteration recognised 3 grades of severity depending on the degree of hypoxaemia and stipulated the application of at least 5 cmH2O of positive end-expiratory pressure PEEP or continuous positive airway pressure. It is based on the level of PEEP, the ratio of the partial pressure of arterial oxygen PaO2 to the fraction of inspired oxygen FiO2 , the dynamic lung compliance and the degree of radiographic infiltration. The outcome of these patients is determined by the underlying causes of ARDS, patient-specific factors such as comorbidities, clinical management and the severity of illness.
Epidemiology and outcomes Using the AECC definition, several population-based studies of ARDS showed a fairly consistent picture of the age, mortality and severity of illness; however, there was almost a fourfold difference in incidence, probably contributed to by differences in study design and ICU utilisation.
Only To those ends, the investigators recorded admissions over 4 weeks to ICUs in 50 countries over 5 continents including 29 patients. In total, Therefore, ARDS is important both clinically and financially, because it is a not uncommon contributor to the deaths of critically ill patients of all ages and because survivors carry on suffering from the sequelae of critical illness long after they leave hospital.
The combination of these two processes causes profound hypoxaemia and eventually type 2 respiratory failure as hyperventilation fails to keep pace with carbon dioxide production. Diagnosis Any diagnostic strategy for ARDS is sufficiently dependent on local factors, such as the prevalent causes of infectious pneumonia and access to imaging modalities, that a single protocol cannot be recommended. An exemplar from a tertiary referral centre used to dealing with complex and very severe cases is included figure 1 , p43— There are two main broad categories of condition that resemble ARDS but have a distinct pathophysiology: first, cardiovascular conditions of rapid onset including left heart failure, right-to-left vascular shunts usually with some lung pathology and major pulmonary embolism; second, lung conditions which develop more slowly than ARDS, for example, interstitial lung diseases especially acute interstitial pneumonia , bronchoalveolar cell carcinoma, lymphangitis and the pulmonary vasculitides.
NHLBI ARDS Network
ARDSnet Ventilation Strategy
Guidelines on the management of acute respiratory distress syndrome