This protocol covers acute respiratory failure arising in the context of acute respiratory distress syndrome (ARDS), specifically where the PaO2/FIO2 ratio falls at or below 300 under positive-pressure respiratory support.
The patient meets the Berlin definition of ARDS: PaO2/FIO2 ratio ≤ 300 under PEEP or CPAP of at least 5 cmH2O, acute onset within one week, bilateral opacities on chest imaging, and respiratory failure not fully explained by cardiac failure or fluid overload alone.
In severe ARDS meeting established criteria, the management approach may involve extracorporeal membrane oxygenation (ECMO) — the full protocol details the specific modality, indication thresholds, and clinical pathway.
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.
In the latest ELSO guidelines, common indications for veno-venous ECMO are: (1) hypoxemic respiratory failure (PaO2/FiO2 < 80 mmHg) after optimal medical management including, in the absence of contraindications, a trial of prone positioning.
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