Treatment of Chronic Respiratory Failure in Acute Respiratory Distress Syndrome with PaO2/FiO2 ≤ 300
This protocol addresses chronic respiratory failure occurring in the setting of acute respiratory distress syndrome (ARDS), specifically where the PaO2/FiO2 ratio is 300 or below and bilateral lung-field shadows are present.
Clinical scenario
The diagnosis is based on the Berlin definition criteria: a PaO2/FiO2 ratio ≤ 300 under positive end-expiratory pressure, bilateral shadows on chest imaging, and respiratory failure not solely explained by cardiac failure or fluid overload. Recognising this constellation drives the selection of the appropriate ventilatory approach.
Treatment approach (partial overview)
Management in this scenario centres on specific ventilatory strategies targeting moderate-to-severe ARDS — including pressure-limiting techniques and positional interventions.
Full regimen, sequencing, and parameters available in the complete protocol →
References
DOI: 10.1186/s40560-023-00658-3
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.
Limiting plateau pressure and high-level PEEP is recommended weakly to strongly in all guidelines, although the most recent Cochrane analysis did not find a survival benefit for high-level PEEP.
Prone position ventilation with prolonged hours is weakly to strongly recommended for moderate-to-severe ARDS in all guidelines.
Early and limited use of muscle relaxants are weakly to strongly recommended for patients with moderate to severe ARDS.
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