Acute Respiratory Failure in Acute Respiratory Distress Syndrome with Bilateral Shadows

Clinical Scenario

This protocol addresses acute respiratory failure arising in the context of acute respiratory distress syndrome (ARDS) — a serious condition characterised by bilateral lung infiltration.

The diagnosis follows the Berlin definition, requiring all of the following:

Bilateral shadows in the lung fields
PaO₂/FIO₂ ratio at or below 300 under PEEP/CPAP of at least 5 cmH₂O
Acute onset within one week
Respiratory failure not explained by cardiac failure or excess fluid alone

Treatment Approach

For severe ARDS meeting these criteria, the protocol involves an advanced extracorporeal intervention — one now addressed in major international guidelines. The specific criteria for initiation, patient selection, and management steps are detailed in the full protocol.

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References

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.

The benefit of extracorporeal membrane oxygenation (ECMO) has been clarified in recent studies, with ECMO now weakly recommended for severe ARDS in most guidelines.

DOI: 10.1186/s40560-023-00658-3

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