Acute respiratory failure
ICD-10 J96.0 · ICD-11 CB41.0Z

Treatment of Acute Respiratory Failure in Acute Respiratory Distress Syndrome (ARDS) with Bilateral Shadows

Acute respiratory distress syndrome (ARDS) is a serious cause of acute respiratory failure, characterised by bilateral lung infiltration and a defined set of clinical and physiological criteria. This page outlines the first-line management approach for this presentation.

Clinical scenario — ARDS (Berlin definition)
First-line approach

Initial management involves noninvasive respiratory support — high-flow nasal cannula (HFNC) and noninvasive positive pressure ventilation (NPPV) are recommended as alternative options — combined with restrictive fluid management and a corticosteroid therapy course.

Full criteria, sequencing, and the complete regimen are in the structured protocol →

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1186/s40560-023-00658-3

Among ARF, acute respiratory distress syndrome (ARDS) is a serious condition associated with bilateral lung infiltration.

The clinical diagnosis of ARDS is currently based on the Berlin definition: (1) PaO2/FIO2 ratio <= 300 under positive end-expiratory pressure (PEEP)/continuous positive airway pressure (CPAP) >= 5 cmH2O; (2) acute onset within a week; (3) bilateral shadows in the lung fields, and (4) respiratory failure that cannot be explained by cardiac failure or excess fluid alone.

Regarding ARDS, IPPV has been the gold standard; however, HFNC and NPPV are weakly recommended as alternative options to initial management in JRS/JSICM/JSRCM-GL2021.

Based on this evidence, the JRS/JSICM/JSRCM-GL2021 and FICM/ICS-GL 2018 weakly recommend restrictive fluid management.

Patients in the dexamethasone group were treated with 20 mg intravenous dexamethasone (methylprednisolone equivalent 100-120 mg) daily for five days and 10 mg for additional five days.

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