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S candinavian clinical practice guideline on mechanical ventilation in adults with the acute respiratory distress syndrome
Author(s) -
CLAESSON J.,
FREUNDLICH M.,
GUNNARSSON I.,
LAAKE J. H.,
VANDVIK P. O.,
VARPULA T.,
AASMUNDSTAD T. A.
Publication year - 2015
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12449
Subject(s) - medicine , ards , mechanical ventilation , guideline , intensive care medicine , ventilation (architecture) , randomized controlled trial , tidal volume , intensive care , evidence based medicine , emergency medicine , anesthesia , surgery , respiratory system , lung , alternative medicine , mechanical engineering , pathology , engineering
Background The objective of the S candinavian Society of Anaesthesiology and Intensive Care Medicine ( SSAI ) task force on mechanical ventilation in adults with the acute respiratory distress syndrome ( ARDS ) is to formulate treatment recommendations based on available evidence from systematic reviews and randomised trials. Methods This guideline was developed according to standards for trustworthy guidelines through a systematic review of the literature and the use of the Grading of Recommendations Assessment, Development and Evaluation system for assessment of the quality of evidence and for moving from evidence to recommendations in a systematic and transparent process. Results We found evidence of moderately high quality to support a strong recommendation for pressure limitation and small tidal volumes in patients with ARDS . Also, we suggest positive end‐expiratory pressure ( PEEP ) > 5 cm H2O in moderate to severe ARDS and prone ventilation 16/24 h for the first week in moderate to severe ARDS (weak recommendation, low quality evidence). Volume controlled ventilation or pressure control may be equally beneficial or harmful and partial modes of ventilatory support may be used if clinically feasible (weak recommendation, very low quality evidence). We suggest utilising recruitment manoeuvres as a rescue measure in catastrophic hypoxaemia only (weak recommendation, low quality evidence). Based on high‐quality evidence, we strongly recommend not to use high‐frequency oscillatory ventilation. We could find no relevant data from randomised trials to guide decisions on choice of FiO 2 or utilisation of non‐invasive ventilation. Conclusion We strongly recommend pressure‐ and volume limitation and suggest using higher PEEP and prone ventilation in patients with severe respiratory failure.