This protocol covers chronic respiratory failure occurring in the context of acute respiratory distress syndrome (ARDS), where the PaO2/FIO2 ratio is ≤ 300 and bilateral shadows are present in the lung fields.
ARDS is diagnosed by the Berlin definition: a PaO2/FIO2 ratio ≤ 300 under PEEP or CPAP, acute onset within one week, bilateral shadows in the lung fields, and respiratory failure not explained by cardiac failure or excess fluid alone.
For severe ARDS, current evidence and leading guidelines support the use of extracorporeal membrane oxygenation — the complete protocol details the specific indications, patient selection criteria, and management pathway.
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 cmHO2; (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; (2) hypercapnic respiratory failure (pH < 7.25) despite optimal conventional mechanical ventilation (respiratory rate 35 breaths per minute and plateau pressure [Pplat] ≤ 30 cm H2O); and (3) ventilatory support as a bridge to lung transplantation or primary graft dysfunction following lung transplantation.
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