La insuficiencia respiratoria aguda (IRA) que ocurre en el contexto del síndrome de dificultad respiratoria aguda (SDRA) con infiltración pulmonar bilateral es una presentación crítica que requiere una estrategia de ventilación estructurada y basada en evidencia.
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.
Low tidal volume ventilation is weakly recommended for ARF in SSCG2021 and SRLF-GL2019, and strongly recommended for ARDS in JRS/JSICM/JSRCM-GL2021, SSCG2021, SRLF-GL2019 and FICM/ICS-GL2018.
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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