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Current and evolving standards of care for patients with ARDS.
Menk, Mario; Estenssoro, Elisa; Sahetya, Sarina K; Neto, Ary Serpa; Sinha, Pratik; Slutsky, Arthur S; Summers, Charlotte; Yoshida, Takeshi; Bein, Thomas; Ferguson, Niall D.
  • Menk M; Department of Anesthesiology and Operative Intensive Care Medicine, CCM / CVK Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany.
  • Estenssoro E; Berlin Institute of Health, ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Sahetya SK; Division of Critical Care, Hospital Interzonal de Agudos San Martin de La Plata, Buenos Aires, Argentina.
  • Neto AS; Facultad de Ciencias Medicas, University of Nacional de La Plata, Buenos Aires, Argentina.
  • Sinha P; Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Slutsky AS; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia.
  • Summers C; Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital and University of Melbourne, Melbourne, Australia.
  • Yoshida T; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
  • Bein T; Department of Anesthesia, Division of Critical Care, Washington University, Saint Louis, MO, USA.
  • Ferguson ND; Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Intensive Care Med ; 46(12): 2157-2167, 2020 12.
Article in English | MEDLINE | ID: covidwho-911887
ABSTRACT
Care for patients with acute respiratory distress syndrome (ARDS) has changed considerably over the 50 years since its original description. Indeed, standards of care continue to evolve as does how this clinical entity is defined and how patients are grouped and treated in clinical practice. In this narrative review we discuss current standards - treatments that have a solid evidence base and are well established as targets for usual care - and also evolving standards - treatments that have promise and may become widely adopted in the future. We focus on three broad domains of ventilatory management, ventilation adjuncts, and pharmacotherapy. Current standards for ventilatory management include limitation of tidal volume and airway pressure and standard approaches to setting PEEP, while evolving standards might focus on limitation of driving pressure or mechanical power, individual titration of PEEP, and monitoring efforts during spontaneous breathing. Current standards in ventilation adjuncts include prone positioning in moderate-severe ARDS and veno-venous extracorporeal life support after prone positioning in patients with severe hypoxemia or who are difficult to ventilate. Pharmacotherapy current standards include corticosteroids for patients with ARDS due to COVID-19 and employing a conservative fluid strategy for patients not in shock; evolving standards may include steroids for ARDS not related to COVID-19, or specific biological agents being tested in appropriate sub-phenotypes of ARDS. While much progress has been made, certainly significant work remains to be done and we look forward to these future developments.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Standard of Care Type of study: Prognostic study / Reviews Topics: Long Covid Limits: Humans Language: English Journal: Intensive Care Med Year: 2020 Document Type: Article Affiliation country: S00134-020-06299-6

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Standard of Care Type of study: Prognostic study / Reviews Topics: Long Covid Limits: Humans Language: English Journal: Intensive Care Med Year: 2020 Document Type: Article Affiliation country: S00134-020-06299-6