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Scandinavian clinical practice guideline on mechanical ventilation in adults with the acute respiratory distress syndrome.

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Authors
Claesson, J
Freundlich, M
Gunnarsson, I
Laake, J H
Vandvik, P O
Varpula, T
Aasmundstad, T A
Issue Date
2015-03

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Citation
Acta Anaesthesiol Scand. 2015, 59 (3):286-97
Abstract
The objective of the Scandinavian 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.
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.
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 FiO2 or utilisation of non-invasive ventilation.
We strongly recommend pressure- and volume limitation and suggest using higher PEEP and prone ventilation in patients with severe respiratory failure.
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To access publisher's full text version of this article click on the hyperlink at the bottom of the page
Additional Links
http://dx.doi.org/ 10.1111/aas.12449
http://onlinelibrary.wiley.com/doi/10.1111/aas.12449/epdf
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Archived with thanks to Acta anaesthesiologica Scandinavica
ae974a485f413a2113503eed53cd6c53
10.1111/aas.12449
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